Ovarian cancer Flashcards
Is screening for ovarian cancer currently done in Australia? Why/why not? What is the best current screening test?
No - tests aren’t sensitive or specific enough. Would need 20 laparotomies to diagnose single cancer. Best method is a transvaginal U/S + Ca125
Name 2 populations where screening for ovarian cancer is warranted. If positive, name 2 interventions that can be done to prevent ovarian cancer and why.
People with strong family histories (or proven genotype) of BRCA1/2 mutations, or HNPCC (Lynch syndrome)
Mx - bilateral prophylactic oopherectomy (get rid of the ovaries) +/- salpingectomy (high grade serous ovarian cancers are believed to arise from the Fallopian tube)
What is the most accurate blood marker of ovarian cancer? Is it good - why/why not (2 main reasons)? Name 3 other conditions that might give a false positive result. Besides for screening/diagnosis, what is another use of this blood marker in ovarian cancer?
Ca125 - not great.
High false negative rate (50% of stage 1 ovarian cancer will have normal Ca125)
High false positive rate - premenopausal conditions (menstruation, fibroids, endometriosis, PID, pregnancy), cardiac or liver failure, peritonitis. Ca125 released from anything that irritates mesothelial surfaces (peritoneum, pleura). Often raised in pre-menopausal women.
Also used for monitoring response of Ca to therapy
Why is CEA often used as an investigation into an ovarian mass?
CEA released mainly from gut cancers, which can sometimes spread to ovary. Positive CEA + ovarian mass suggests a colorectal origin of the tumour, which needs very different management than a primary ovarian tumour (colorectal tumours respond poorly to surgery, ovarian tumours respond well to surgery)
What are the common features of history and examination of ovarian cancer? Name 3 differentials. Name 1 risk factor and 3 preventative factors.
History - usually > 65 years, often poorly defined symptoms - constitutional symptoms (anorexia, cachexia), abdominal swelling, abdo pain, dyspepsia, nocturia, dysuria
Examination - pelvic mass on pelvic examination
Ddx - Irritable bowel syndrome, metastases to the ovary, endometriosis, UTI, anaemia
Risk factor - nulliparity, FHx
Preventative factors - pregnancy, combined OCP, breast feeding
Name 3 investigations you should order if you are suspicious of ovarian cancer. What are the expected results if these Ix are positive?
Transvaginal U/S - solid and cystic mass +/- thickened septae, calcification, ascites, intraabdominal metastases. Reduced resistance to blood flow on Doppler studies (reflecting neovascularisation)
CT +/- PET - look for peritoneal thickening, enlarged lymph nodes, ascites, omental thickening, liver mets
CA125 and CEA - both may be raised
What index is often used to determine if a woman has a high chance of ovarian cancer? Name the 3 components of it
Relative malignancy index - based off menopausal status (higher if post-menopause), U/S features of cyst, and Ca125 levels.
Name 3 Ddx for an ovarian cyst seen on U/S
Benign - functional, dermoid, endometrioma, haemorrhagic
Malignant - epithelial, germ cell, stromal origin
Name 2 modes of management of an ovarian cancer. Name 3 ways of following up response to treatment
Surgery - often total abdominal hysterectomy + bilateral salpingo-oopherectomy (TAH-BSO)
Chemotherapy - usually platinum-based drugs
Use CA-125, CT, MRI to assess response to treatment
What is the most common type of ovarian cancer?
Serous adenocarcinoma
What would bilateral ovarian tumours suggest?
They may be a metastatic (not primary) ovarian cancer - 70% of bilateral ovarian tumours are mets
Name the 3 most common primary tumours that metastasise to the ovary. What proportion of ovarian tumours are metastatic?
GIT, breast, endometrial
5% are metastatic
