Ovarian Cancer

Question 1

Describe the types of Ovarian cancer.

Answer 1

1. Epithelial Ovarian tumours: 89-90% of all ovarian cancer. Arise from epithelial surface of the ovary. >50 years.
2. Germ cell tumours: 2-10% of ovarian tumours. <35 years. Rapidly enlarge and can rupture or cause ovarian torsion.
3. Borderline Tumours: 10-15% of ovarian tumours.
4. Metastatic tumours: breast, GI tract, uterus, cervix, haemopoietic system.
5. Others

Question 2

What age group most commonly gets ovarian cancer?

Answer 2

60 years.

Question 3

Describe the risk factors for Ovarian Ca.

Answer 3

• Lifestyle is 21% attributable. (smoking, obesity, lack of exercise)
• Use of fertility drugs (clomifene)
• Early menarche and late menopause. (greater cycle of cells)
• Family history – 3 to 4 rimes more likely.
• Genetics – BRCA1 and BRCA2
• Endometriosis.
• HRT – small increased risk if used for more than 5 years.

Question 4

Describe the protective factors for Ovarian Ca.

Answer 4

• Pregnancy
• Breast feeding
• Early menopause
• COCP

Question 5

What is the presentation of Ovarian Ca like?

Answer 5

• 75% present with advanced stages (3 or 4).
• Abdominal distension and bloating
• Abdominal and pelvic pain
• Urinary symptoms e.g. urgency
• Early satiety
• Diarrhoea.

Question 6

What investigations should you do?

Answer 6

Ca-125 then USS if raised.

Question 7

What is the sensitivity of pelvic examination for detecting pelvic masses in ovarian cancer?

Answer 7

Only around 45%

If examination is normal, you should move on to measuring the tumour marker Ca-125 to improve detection rates.