Ovarian Cancer Flashcards
From where does ovarian cancer arise?
Most actually arise from the fallopian tube
Some arise from benign ovarian cysts, these are generally lower grade cancers
Some people are at a higher genetic risk of developing ovarian cancer, who dis?
- People in HNPCC families
- Or carriers of BRCA genes
What are the BRCA genes?
Tumour suppressor genes
Certain mutations are passed on by Autosomal Dominant inheritence
How much risk are BRCA 1 & 2 carriers at?
15-45% lifetime risk of Ovarian Cancer
Also develop Ovarian and breast very young
What other things are risk factors for Ovarian CanceR?
Being older Incessant ovulation (i.e. not using OCP or being pregnant)
How does Ovarian Cancer present?
Very vague symptoms e.g.:
- Indigestion/poor appetite
- Altered bowel habit & pain
- Bloating, discomfort & weight gain
- Feeling a pelvic mass and pressure symptoms
How do we test if we suspect ovarian cancer?
Start with an abdo & pelvic US followed by CT
Also do a CA 125 test
What is CA 125?
A serum biomarker raised in peritoneal damage e.g. ascites, endometriosis, PID, breast cancer, liver disease or ovarian cancer
We can’t check directly for ovarian cancer from the outside so how to we assess the likelihood?
With a risk of malignancy index (RMI): US x M x CA125
US - US features of malignancy
M - Menopausal status
What US featuers apply to the RMI?
1 feature = 1point
2+ = 3 points
- Multi-locular
- Solid areas
- Bilateral
- Ascites
- Intra-abdominal
How do we score a woman’s menopausal status on RMI?
Pre-menopause = 1 Post-menopause = 3
Whats an abnormal CA125?
> 200 is considered a significant risk
How is Ovarian cancer treated?
Laparotomy with adjuvant/neo-adjuvant chemo
What is ovarian cancer recurs?
2nd line chemo
Repeat surgery
If that fails or isn’t tolerated can try Tamoxifen
How do we stage ovarian cancer/
Pathology after surgery: 1 = Ovarian with capsule intact 2 = spread into pelvis 3 = Peritoneal implants outside pelvis or nodal involvement 4 = Distant mets
