Ovarian Cancer Flashcards
Describe the different classifications of ovarian cancer [+]
Epithelial tumours: 90%: - Majority arised from ovarian surface epithelium. Lots of subtypes:
- Serous (60-70%); develop from fallopian tube epithelium
- Endometrial
- Clear cell
- Mucinous
- Transitional cell (Brenner tumours)
Non-epithelial ovarian carcinomas:
- Germ cell tumours: most common non-epithelial ovarian cancer and in women < 35
- Sex cord and stromal tumours
- Carcinosarcoma
- Small cell cancer
Which type of ovarian cancer is particularly associated with ovarian torsion? [1]
Dermoid Cysts / Germ Cell Tumours
- Teratomas that may contain various tissue types, such as skin, teeth, hair and bone.
Germ cell tumours may have which hormones raised? [2]
Germ cell tumours may cause raised alpha-fetoprotein (α-FP) and human chorionic gonadotrophin (hCG).
Describe what is meant by a Krukenburg tumour [1]
What is their defining histological feature? [1]
A Krukenberg tumour refers to a metastasis in the ovary, usually from a gastrointestinal tract cancer, particularly the stomach.
Krukenberg tumours have characteristic “signet-ring” cells on histology, which look like signet rings on under a microscopy.
What are the risk factors for ovarian cancer?
- Hormonal [3]
- Env [6]
- Genetic [3]
Risk increases with number of ovulatory cycles and age
Hormonal:
* Nulliparity (never having given birth)
* Early menarche & late menopause (as leads to longer ovulatory cycle)
* HRT
Genetic:
* Positive family history
* BRCA 1/ BRCA 2
* Lynch syndrome
Environmental:
* Talcum powder: The use of talcum powder in the genital area has been associated with a slight increase in risk, possibly due to inflammation caused by talc particles.
* Diet: High-fat diet and consumption of animal fats have been implicated in ovarian cancer risk. However, the evidence remains inconclusive.
* Endometriosis: Women with endometriosis have a higher risk of developing certain types of ovarian cancer, particularly clear cell and endometrioid carcinomas. Disputed link
* Smoking
* Asbestos
* Obesity
State stages I-IV of ovarian cancer [4]
- Stage I: Cancer is confined to one or both ovaries.
- Stage II: Cancer has spread to other pelvic structures.
- Stage III: Cancer has spread beyond pelvis or to retroperitoneal lymph nodes.
- Stage IV: Distant metastasis has occurred, such as in liver or lung parenchyma.
Describe the clinical features of ovarian cancer
Often asymptomatic / has non specific symptoms so is diagnosed late
Symptoms:
* abdominal distension and bloating
* abdominal and pelvic pain
* urinary symptoms e.g. Urgency
* early satiety
* diarrhoea
TOMTIP: An ovarian mass may press on the obturator nerve and cause referred hip or groin pain. The obturator nerve passes along the inside of the pelvic, lateral to the ovaries, where an ovarian mass can compress it.
Name three protective factors for ovarian cancer [3]
Combined contraceptive pill
Breastfeeding
Pregnancy
All stop the number of lifetime ovulations
Refer directly on a 2-week-wait referral if a physical examination reveals: [3]
Ascites
Pelvic mass (unless clearly due to fibroids)
Abdominal mass
If you suspect cancer (but not indicated for a 2ww), what initial investigation should you perform? [1]
What level of ^ would indicate further imaging? [1]
What further imaging? [2]
if the CA125 is raised (35 IU/mL or greater) then an urgent ultrasound scan of the abdomen and pelvis should be ordered
Name 4 TVUS findings that would indicate ovarian cancer [4]
- solid areas within the cyst
- irregularity of the cyst wall or septa
- presence of ascites
- increased vascularity on Doppler flow studies.
Which serum marker is used alongisde CA125 to improve S&S? [1]
HE4 (Human epididymis protein 4): This serum marker is used alongside CA-125 to improve sensitivity and specificity in predicting malignancy.
How do you make a definitive dx of ovarian cancer? [1]
A definitive diagnosis of ovarian cancer is made by histopathological examination following surgical removal or biopsy of the mass.
When considering ovarian cancer, it’s essential to differentiate from other conditions that may present similarly. The three most likely alternative diagnoses include [3]
When considering ovarian cancer, it’s essential to differentiate from other conditions that may present similarly. The three most likely alternative diagnoses include endometriosis, ovarian cysts and pelvic inflammatory disease.
How would you differentiate ovarian cancer from endometriosis - symptoms [3]; exam [1]’ TVUS [1]
Symptoms:
- cyclic pelvic pain that correlats with menses
- dyspareunia
- infertility
Physical exam:
- tender nodules in posterior fornix
TVUS:
- characteristic ‘chocolate’ cysts.
Endometriosis is characterised by the presence of endometrial tissue outside the uterus
Describe the management plan for ovarian cancer [+]
1. The primary treatment for most ovarian cancers is surgical debulking, aimed at removing all visible disease. The extent of surgery may include total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymph node dissection.
2. Chemotherapy: is typically administered postoperatively to treat any residual disease. The standard regimen is a combination of carboplatin and paclitaxel. Neoadjuvant chemotherapy may be considered in cases where optimal debulking is not achievable initially.
3. Targeted Therapy: For patients with advanced ovarian cancer, particularly those with BRCA mutations or homologous recombination deficiency, targeted therapies like PARP inhibitors (e.g., olaparib, niraparib) may be indicated.
A 60-year-old woman presents lower abdominal discomfort, urinary frequency, bloating and abdominal distension - ovarian cancer
