Ovarian cancer Flashcards
Why is ovarian cancer known as the silent killer?
More than 70% of patients present after it has spread beyond the pelvis
What are some types of ovarian cancer?
Epithelial cell tumours
Dermoid cysts (Germ cell tumours)
Sex cord-stomal tumours
What are epithelial cell ovarian cancers?
Tumours arising from the epithelial cells of the ovary
What are some sub-types of epithelial cell ovarian tumours
Serous tumours (Most common)
Endometrioid carcinomas
Clear cell tumours
Mucinous tumours
Brenner’s tumour
What is thought to be the origin of epithelial cell tumours
Despite arising from ovarian epithelial tissue, there is no epithelial tissue in a normal ovary
It is thought that the mesothelium of the ovary undergoes metaplasia during break down to allow release of the oocyte
What are the 2 distinct lesions of serous ovarian carcinoma
High grade serous carcinoma
Low grade serous carcinoma
Characteristics of high grade serous ovarian carcinoma
Most cases arise from the Fallopian tube
P53 or BRCA mutation
Characteristics of low grade serous ovarian carcinoma
KRAS or BRAS mutation
Precursor lesion for high grade serous carcinoma
Serous tubal intraepithelial carcinoma (STIC)
Precursor lesion for low grade serous carcinoma
Borderline serous ovarian tumour
Characteristics of mucinous ovarian carcinoma
Can be benign, borderline, malignant or all three at once
Most are metastatic
Show growth of atypical glands and destructive invasion
Characteristics of clear cell and mucinous ovarian tumours
Strong association with endometriosis
Most common in the uterus
Association with Lynch syndrome
What is a Brenner tumour
A tumour of transitional type epithelium
Usually benign
What are germ-cell tumours (Dermoid cysts)
These are benign ovarian tumours. They areteratomas, meaning they come from thegerm cells. They may contain various tissue types, such as skin, teeth, hair and bone.
What is a risk of dermoid cysts
Ovarian torsion
What are some markers suggestive or dermoid cysts?
Alpha-fetoprotein and HCG
What are some rarer forms of germ-cell tumours
- Immature teratoma (No differentiation)
- Dysgerminoma (malignant)
- Yolk sac tumour
- Choriocarcinoma
- Mixed germ cell tumour
What are sex cord-stromal tumours
These are rare tumours, that can be benign or malignant. They arise from thestroma(connective tissue) orsex cords(embryonic structures associated with the follicles).
What are some types of sex cord-stromal tumour
Sertoli-Leydig cell tumours
Granulosa cell tumours
What is a Krukenberg tumour?
A metastasis in the ovary from the GI tract (Usually via the peritoneal cavity)
Histology of Krukenberg tumours
characteristic “signet-ring” cells on histology, which look like signet rings on under a microscopy.
Risk factors for ovarian cancer
- Age (peaks age 60)
- BRCA1 and BRCA2 genes (consider the family history)
- Increased number of ovulations
- Obesity
- Smoking
- Recurrent use of clomifene
What are some factors that increase the number of ovulations and therefore the risk of ovarian cancer
- Early-onset of periods
- Late menopause
- No pregnancies
What are some protective factors for ovarian cancer
- Combined contraceptive pill
- Breastfeeding
- Pregnancy
(All reduce number of ovulations)
What are some symptoms of ovarian cancer
- Abdominal bloating
- Early satiety (feeling full after eating)
- Loss of appetite
- Pelvic pain
- Urinary symptoms (frequency / urgency)
- Weight loss
- Abdominal or pelvic mass
- Ascites
- Hip or groin pain
How can ovarian cancer cause hip or groin pain?
Compression of the obturator nerve
Referral criteria for 2-week-wait referral for suspected ovarian cancer
Ascites
Pelvic mass
Abdominal mass
Referral criteria for CA-125 blood test (Especially in those >50 years)
- New symptoms of IBS / change in bowel habit
- Abdominal bloating
- Early satiety
- Pelvic pain
- Urinary frequency or urgency
- Weight loss
Initial investigations for suspected ovarian cancer in women >40
CA-125 blood test
Pelvic USS
Initial investigation for suspected ovarian cancer in women >40
Ca-125 blood test
Pelvic USS
Alpha-fetoprotein bloods
HCG bloods
LDH bloods
What scoring system is used in ovarian cancer risk
Risk of Malignancy Index (RMI)
How is RMI calculated
A - Menopausal status:
Pre-menopausal = 0 points
Post-menopausal = 3 points
B - Ultrasound findings:
1 abnormal finding = 1 point
>1 abnormal finding = 3 points
C - CA-125 level:
Use value
RMI = A x B x C
What are some other investigations that may be used in ovarian cancer
CT scan
Histology (Tissue sample)
Paracentesis (Ascititic tap)
What are some causes of raised CA-125
- Epithelial ovarian cancer
- Endometriosis
- Fibroids
- Adenomyosis
- Pelvic infection
- Liver disease
- Pregnancy
FIGO stage 1 ovarian cancer
Confined to the ovary
FIGO stage 2 ovarian cancer
Spread past ovary but inside the pelvis
FIGO stage 3 ovarian cancer
Spread past pelvis but inside abdomen
FIGO stage 4 ovarian cancer
Spread outside the abdomen
Most common sites of metastasis form the ovaries
Stomach
Colon
Breast
Pancreas
Management of ovarian cancer
Laparotomy
Hysterectomy, BSO, infra colic omentectomy
Supraradical surgery
Chemotherapy
Most common chemotherapy drugs in ovarian cancer
Carboplatin ± Paclitaxel
6 cycles
Ovarian cancer chemotherapy response rate
60-70% but high relapse rate
