Ovarian cancer

Question 1

incidence of ovarian cancer

Answer 1

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

Question 2

who is at risk of ovarian cancer

Answer 2

Rare < 30 years
High risk families 5-10% of cases
HNPCC/Lynch type II familial cancer syndrome
BRCA1
BRCA2
‘Incessant ovulation’
OCP protective

Question 3

typical origin of ovarian cancer

Answer 3

Most cases probably actually originate from the fallopian tube

Some derive from pre-existing benign ovarian cysts (often low grade cancers)

Question 4

BRAF KRAS NRAS ERBB2 origins and pathogenesis

Answer 4

ovarian surface epithelium –> cortical inclusion cysts –> serous cystadenoma –> serous borderline tumour

Question 5

ARID1A
PIK3CA
PTEN

Answer 5

endometriosis - endometriod carcinoma - clear cell carcinoma

Question 6

P53
BRCA1
BRCA2

Answer 6

fimbriae of fallopian tube
serous tubal Intraepithelial carcinoma
high grade serous carcinoma

Question 7

Ovarian Cancer
Symptoms

Answer 7

Vague!
Indigestion/early satiety/poor appetite
Altered bowel habit/pain
Bloating/discomfort/weight gain
Pelvic mass
asymptomatic
pressure symptoms

Question 8

Ovarian Cancer
Diagnosis

Answer 8

Surgical/Pathological
US Scan abdomen and pelvis
CT Scan

CA 125

Surgery

Question 9

what is CA 125

Answer 9

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

Question 10

Ultra sound features ovarian Cancer

Answer 10

lid areas
bilateral
ascites
intra-abdominal

Question 11

RMI=

Answer 11

U x M x CA 125

Question 12

treatment ovarian Cancer

Answer 12

Surgery
Chemotherapy
Adjuvant
Neo-adjuvant

Question 13

Ovarian Cancer
Laparotomy

Answer 13

Obtain tissue diagnosis
Stage disease
Disease clearance
Debulk disease

Question 14

Ovarian Cancer
Chemotherapy

Answer 14

First line Platinum and taxane (Taxol)
Within 8 weeks of surgery
Complete/partial response
Cure unlikely
Average response 2 years

Question 15

New Therapeutics

Answer 15

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

Question 16

PARPi: OLAPARIB

Answer 16

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

Question 17

PARPi: NIRAPARIB

Answer 17

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

Question 18

Recurrence

Answer 18

Chemotherapy
Palliation
symptomatic recurrence
Platinum if > 6months
Surgery in selected patients
Tamoxifen