Ovarian Cancer Flashcards
Epidemiology of Ovarian Tumors
80% are benign - present at 20-45yrs
20% are malignant - present at 40-65yrs
Ovarian tumors account for 6% of female cancers
Incidence of Ovarian Ca
14/100,000 in the UK –> 6,000 cases annually
Most commonly in post-menopausal women
5% are due to familial causes
Aetiology of Ovarian Ca
BRAC1 & 2 - cause familial ovarian cancer which presents early, otherwise risk increases with age
Pathogenesis poorly understood but nulliparity, FH and gonadal dysgenesis are also risk factors
Presentation of Ovarian Ca
Presents late with non-specific symptoms - has poor prognosis. Eg -Abdo pain/distension and ascites, Urinary and bowel symptoms, pelvic mass
anorexia & weight loss
Post-menopausal bleeding
Diagnosis of Ovarian Ca
Trans-vaginal scan will show a ovarian mass which may be cystic or solid.
CA125 is an acute phase protein which is very high in ovarian Ca - particularly in serous Ca
Classification of Ovarian Ca
V. complicated - can be surface epithelial, germ cell or stroma
Can be combinations of benign, borderline and malignant
Commonly bilateral
Epithelial Ovarian Cancers
Can be serous, mucinous, transitional or endometriod - no one is sure why
90% of ovarian tumours are of this type
Stroma Ovarian Cancers
Rare, can be thecal or other (sertoli cell or granulosa cell tumours)
Often secrete hormones
Germ Cell Ovarian Cancers
Can be malignant or benign (tetraomas) - can have hair, teeth and brain sometimes.
Yolk sac tumours
Serous Ovarian cancers
60% benign, 15% borderline and 25% malignant
Can be very large, part solid and part cystic and multilobulated
Capsule may be intact (smooth shiny surface) or papillated
Malignant serous tumours may have Psammoma bodies which are concentric, laminated, calcified concentrations
Mucinous Ovarian Cancers
80% mucinous, 10% borderline, 10% malignant
Can be very large, part solid and part cystic and multilobulated
Can cause pseudomyxoma peritonei
Can secrete Oestrogen (commonest oestrogen secreting tumour)
Pseudomyxoma peritonei
epithelial implants on the peritoneum and omentum leading to mucinous ascites and intestinal obstruction
Krukenberg tumour
A bilateral metastatic tumour on the ovaries from the stomach or more rarely, the breast
Spread of Ovarian tumours
Can spread to the uterus and via blood but also spread intra-abdominally - peritoneal implants and bowel infiltrates - can eventually spread to the lungs and the liver
Borderline tumors
Where there are dysplastic features –> multilayering of cells, nuclear atypia and mitotic activity but no stroma invasion
More common in younger women
Staging of Ovarian cancers
T1 - limited to ovaries - a - unilateral, b - bilateral, c - capsule rupture
T2 - pelvic spread - a - uterus+tube, b - rest of pelvis, c - Ca in ascites/washings
T3 - peritoneal metastasis beyond the pelvis - a - microscopic mets, b - macroscopic mets 2cm +-nodes
M1 - distant mets
Mangement of Ovarian Ca
Staging laparotomy/scans –> TAH+BSO+removal of any other macroscopic disease
T2+ –>give cisplatin/carboplatin+taxol chemo
If severe may have chemo before surgery as well
Five year survival of malignant epithelial ovarian tumours
Stage 1 (well differentiated) - 70%, (poorly differentiated) - 60%
Stage 3 - 15%
If borderline 100% at stage 1, 90% at stage 3
Follow-up after treatment
If advanced disease 3 monthly follow up with a 75%+ chance of re-occurrence within two years
Risk factors for Ovarian Ca
Parity to full term and COC use has a protective effect while HRT is associated with 19-24% risk of ovarian cancer
BRAC1/2 are the single largest RFs
Obesity is also important - BMI of 30> gives 30% increased risk compared to BMI <24 in premenopausal women
Fallopian tube Cancer
Rare and typically presents with intermittent abdo pain which is relieved by a sudden watery discharge.
