Ovarian Cancer

Question 1

Epidemiology of Ovarian Tumors

Answer 1

80% are benign - present at 20-45yrs
20% are malignant - present at 40-65yrs
Ovarian tumors account for 6% of female cancers

Question 2

Incidence of Ovarian Ca

Answer 2

14/100,000 in the UK –> 6,000 cases annually
Most commonly in post-menopausal women
5% are due to familial causes

Question 3

Aetiology of Ovarian Ca

Answer 3

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

Question 4

Presentation of Ovarian Ca

Answer 4

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

Question 5

Diagnosis of Ovarian Ca

Answer 5

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

Question 6

Classification of Ovarian Ca

Answer 6

V. complicated - can be surface epithelial, germ cell or stroma
Can be combinations of benign, borderline and malignant
Commonly bilateral

Question 7

Epithelial Ovarian Cancers

Answer 7

Can be serous, mucinous, transitional or endometriod - no one is sure why
90% of ovarian tumours are of this type

Question 8

Stroma Ovarian Cancers

Answer 8

Rare, can be thecal or other (sertoli cell or granulosa cell tumours)
Often secrete hormones

Question 9

Germ Cell Ovarian Cancers

Answer 9

Can be malignant or benign (tetraomas) - can have hair, teeth and brain sometimes.
Yolk sac tumours

Question 10

Serous Ovarian cancers

Answer 10

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

Question 11

Mucinous Ovarian Cancers

Answer 11

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)

Question 12

Pseudomyxoma peritonei

Answer 12

epithelial implants on the peritoneum and omentum leading to mucinous ascites and intestinal obstruction

Question 13

Krukenberg tumour

Answer 13

A bilateral metastatic tumour on the ovaries from the stomach or more rarely, the breast

Question 14

Spread of Ovarian tumours

Answer 14

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

Question 15

Borderline tumors

Answer 15

Where there are dysplastic features –> multilayering of cells, nuclear atypia and mitotic activity but no stroma invasion
More common in younger women

Question 16

Staging of Ovarian cancers

Answer 16

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

Question 17

Mangement of Ovarian Ca

Answer 17

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

Question 18

Five year survival of malignant epithelial ovarian tumours

Answer 18

Stage 1 (well differentiated) - 70%, (poorly differentiated) - 60%
Stage 3 - 15%
If borderline 100% at stage 1, 90% at stage 3

Question 19

Follow-up after treatment

Answer 19

If advanced disease 3 monthly follow up with a 75%+ chance of re-occurrence within two years

Question 20

Risk factors for Ovarian Ca

Answer 20

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

Question 21

Fallopian tube Cancer

Answer 21

Rare and typically presents with intermittent abdo pain which is relieved by a sudden watery discharge.