Ovarian Cancer Flashcards
What increases chance of getting ovarian canceR?
no. of times u have ovulated increases risk
FHx of tumour marker
What are RF
− Nulliparity
− Early menarche/late menopause
− BRCA 1 and 2
HNPCC (commonest form of hereditary colorectal cancer)
What are protective factors
− Pregnancy
− Breastfeeding
− COCP
− Tubal ligation
What cells are most ovarian cancers made up of
epithelial cells
What is presentation
Often vague sx which can look like IBS or diverticular disease
• Bloating / ‘IBS’ like symptoms
• Weight loss, loss of appetite, early satiety
• Abdominal/pelvic pain
• Fatigue
• Change in bowel habit
• Urinary frequency
• Bowel obstruction
• Cachexia (weakness and wasting of body)
What can be found on examination
→ Fixed abdo/pelvic mass → Ascites → Omental mass → Pleural effusion → Supraclavicular node enlargement
What are ix
- CA125 - w bloating or new IBS symptoms >55
- They have a USS related to symptoms and age
- Referral based on risk of malignancy index
- CXR
- CT abdo/pelvis
- CEA (tumour marker) raised in colorectal cancers but not ovarian
Explain RMI
Risk of malignancy index
RMI = U x M x CA125
U = US score (0, 1 or 3)
M = menopausal status (1 = premenopausal, 3 = postmenopausal)
What is low risk score of RMI
<25
What is mod risk of RMI
25-250
What is high risk of RMI
> 250
Explain FIGO staging of ovarian cancer
I One or both ovaries II Limited to pelvis III Limited to abdomen, including regional LN IV Distant metastases outside abdo cavity
What is treatment
Surgery (full stage laparotomy) + neoadjuvant chemo
platinum therapy - carboplatin or paclitaxel
What is involved in full stage laparatomy
i. Midline laparotomy
ii. Hysterectomy
iii. Bilateral salpingo-oophorectomy
iv. Omentectomy
v. Para-aortic and pelvic LN sampling
vi. Peritoneal washings and biopsies
