Ovarian cancer Flashcards
Ovarian cancer risk factors
nulliparity
early menarche
late menopause
increased age
fertility treatment
white race
resident in north america/northern europe
FH
personal hx breast cancer
What inherited cancer predisposition syndromes can cause ovarian cancer?
BRCA1
BRCA1
HNPCC (lynch 2)
Pathology of ovarian tumours
epithelial tumours:
- serous
- mucinous
- endometrioid
- clear cell
- undifferentiated
- brenner
borderline tumours
germ cell tumours
sex cord stromal tumours
secondary tumours can occur (breast and bowel)
Ovarian cancer symptoms
abdominal discomfort
clothes too tight
pelvic pressure
indigestion
weight loss
anorexia
Ovarian cancer signs
pelvic mass
ascites
enlarged lymph nodes
pleural effusion
NICE guidelines for investigation of ovarian-suspicious cancer in primary care
use Ca125 as primary investigation
if raised then USS
refer if both positive
if Ca125 is raised and USS normal, consider other causes
refer others if symptoms persist
FIGO staging of ovarian cancer
stage 1 = confined to ovaries
stage 2 = confined to pelvis
stage 3 = outside pelvis
stage 4 = distant mets (liver, lung etc)
What conditions other than ovarian cancer can raise Ca125?
inflammation
fibroids
endometriosis
pregnancy
diverticulitis
Signs of advanced ovarian cancer on CT
pelvic masses
ascites
lymphadenopathy
omental cake
How do you calculate RMI and what is it?
risk of malignancy index
UxMxCa124
U = ultrasound score
M = menopausal status
Treatment of suspected early stage ovarian cancer
laparotomy and inspection of peritoneal cavity
removal of ovarian mass
confirmed as malignant:
- hysterectomy
- removal of remaining ovary
- omentectomy
- appendectomy
- peritoneal biopsies
- pelvic and para-aortic lymphadenectomy up to renal vessels
Patterns of spread of ovarian cancer
intraperitoneally following path of peritoneal fluid
lymphatic spread –> pelvic and/or para-aortic lymph nodes
haematogenous spread –> parenchymal metastases of liver, lungs, brain
Prognostic factors in ovarian cancer
tumour stage and type
age
performance status
degree of debulking at primary laparotomy
Who do malignant ovarian germ cell tumours typically affect?
young women (10-30y)
eg. dysgerminomas, immature teratomas, yolk sac tumours
What tumour markers can be present in ovarian germ cell tumours?
hCG - dysgerminomas, embryonal carcinomas, ovarian choriocarcinomas
AFP - endodermal sinus tumours, embryonal carcinomas
LDH - dysgerminomas
Clinical presentation of ovarian germ cell tumours
presence of pelvic mass
precocious puberty or symptoms of pregnancy
Where do sex cord stromal tumours arise from?
gonadal stroma surrounding the oocytes
