Ovarian cancer Flashcards
incidence of ovarian cancer
600 cases per year in Scotland
400 deaths per year in Scotland
23.8 per 100,000 women per year
5 year survival all stages 40-45%
Most present with advanced disease
who is at risk of ovarian cancer
Rare < 30 years
High risk families 5-10% of cases
HNPCC/Lynch type II familial cancer syndrome
BRCA1
BRCA2
‘Incessant ovulation’
OCP protective
typical origin of ovarian cancer
Most cases probably actually originate from the fallopian tube
Some derive from pre-existing benign ovarian cysts (often low grade cancers)
BRAF KRAS NRAS ERBB2 origins and pathogenesis
ovarian surface epithelium –> cortical inclusion cysts –> serous cystadenoma –> serous borderline tumour
ARID1A
PIK3CA
PTEN
endometriosis - endometriod carcinoma - clear cell carcinoma
P53
BRCA1
BRCA2
fimbriae of fallopian tube
serous tubal Intraepithelial carcinoma
high grade serous carcinoma
Ovarian Cancer
Symptoms
Vague!
Indigestion/early satiety/poor appetite
Altered bowel habit/pain
Bloating/discomfort/weight gain
Pelvic mass
asymptomatic
pressure symptoms
Ovarian Cancer
Diagnosis
Surgical/Pathological
US Scan abdomen and pelvis
CT Scan
CA 125
Surgery
what is CA 125
Glyco-protein antigen
also raised in :
Malignancy
ovary
colon/pancreas
breast
Benign conditions
menstruation/endometriosis/PID
liver disease/recent surgery/effusions
80% of women with ovarian cancer have a raised CA 125
50% of women with stage 1 disease
Used in detecting and monitoring epithelial ovarian tumours
Ultra sound features ovarian Cancer
lid areas
bilateral
ascites
intra-abdominal
RMI=
U x M x CA 125
treatment ovarian Cancer
Surgery
Chemotherapy
Adjuvant
Neo-adjuvant
Ovarian Cancer
Laparotomy
Obtain tissue diagnosis
Stage disease
Disease clearance
Debulk disease
Ovarian Cancer
Chemotherapy
First line Platinum and taxane (Taxol)
Within 8 weeks of surgery
Complete/partial response
Cure unlikely
Average response 2 years
New Therapeutics
Poly ADP Ribose polymerase inhibitors (PARPi)
Oral agents
Cytotoxic to cells with HRD
Three PARPi approved for use in Scotland
Olaparib, Niraparib, Rucaparib
All patients offered germline and somatic BRCA testing
PARPi: OLAPARIB
2019 Approved for first line maintenance treatment in those with stage 3 or 4 ovarian cancer with germline or somatic BRCA mutations, in response to platinum based chemotherapy
Risk of disease progression 70% lower than in those on placebo (SOLO-1).
PFS at 5 years more than doubled a 5 years Vs placebo
Median disease free survival 56mth vs 14mths
PARPi: NIRAPARIB
2018 Approved for use for platinum sensitive stage 3 and 4 ovary cancer first line post chemotherapy
PFS 14mth vs 8 mth
Time to first subsequent treatment 19 vs 12 mth
2018 Approved for use for platinum sensitive relapsed ovarian cancer with no germline BRCA mutation 1st line
Progression free survival 9.3 vs 3.9 months (Nova study)
PFS 9.3 mth vs 3.9 mth OS increased by 9.7 mth
Recurrence
Chemotherapy
Palliation
symptomatic recurrence
Platinum if > 6months
Surgery in selected patients
Tamoxifen
