Ovarian Cancer Flashcards
List the main groups of ovarian pathology
Cysts
Endometriosis
Tumours
Ovarian cysts usually resolve on their own. True/False?
True
Typically over a few months
List types of ovarian cysts
Follicular Luteal Endometriotic Epithelial Mesothelial
What are the main clinical signs of endometriosis?
Pelvic inflammation
Infertility
Pain
List some common sites of endometriosis
Ovary Pouch of Douglas Peritoneum Cervix, vulva, vagina Bladder Bowel
What is the typical appearance of endometriosis in the ovary?
Chocolate cysts
Peritoneal spots or nodules
Fibrous adhesions
List complications of endometriosis
Cyst formation Ectopic pregnancy Endometrial carcinoma Adhesions Infertility
List the main classifications of ovarian tumours and their relative prevalence
Epithelial (55-70%) Germ cell (15-20%) Sex cord/ stromal Metastatic Miscellaneous
List the main epithelial ovarian tumours
Serous Mucinous Endometrioid Clear cell Brenner Undifferentiated carcinoma
What is the precursor for high-grade serous carcinoma of the ovary?
Serous tubal intraepithelial carcinoma (STIC)
Which ovarian cancers are associated with endometriosis?
Endometrioid
Clear cell carcinoma
Most endometrioid cancer is low-grade. True/False?
True
What syndrome is associated with endometrioid cancer?
Lynch syndrome
Diagnosis of epithelial tumours is often made using what type of fluid?
Ascitic fluid
What is Brenner tumour?
Transitional cell epithelium tumour that is usually benign
List the main germ cell tumours that can occur the ovary
Teratoma (mature or immature) Dysgerminomas Yolk sac tumour Choriocarcinoma Mixed germ cell tumour
What is the most common germ cell tumour?
Mature benign cystic teratoma (95%)
What is the most common malignant germ cell tumour? Who does it typically affect?
Dysgerminomas
Children and young woman
List the main sex cord/stromal tumours
Fibroma/thecoma
Granulosa cell tumour
Sertoli-Leydig cell tumours
Sex cord/stromal tumours are associated with an increase in which sex harmone?
Oestrogen
What are the commonest sites that metastasise to the ovary?
Stomach
Colon
Breast
Pancreas
Describe FIGO stage I of ovarian cancer
IA: one ovary
IB: both ovaries
IC: ovary with rupture/spill
Describe FIGO stage II of ovarian cancer
IIA: extension to uterus/fallopian tube
IIB: extension to other pelvic intraperitoneal structure
Describe FIGO stage III of ovarian cancer
IIIA: retroperitoneal lymph node metastasis
IIIB: peritoneal metastasis beyond pelvis up to 2cm
IIIC: peritoneal metastasis beyond pelvic over 2cm
Describe FIGO stage IV of ovarian cancer
IV: distant metastasis
Stae the name for the type of pelvic inflammatory disease occuring in the fallopian tubes
Salpingitis
What emergency condition should be considered in any female of reproductive age with amenorrhea and acute hypotension or an acute abdomen?
Ectopic pregnancy
A smear test can pick up ovarian cancer. True/False?
False
1 in 3 believe it does though
Which BRCA mutation (1 or 2) is more associated with ovarian cancer? List other risk factors
BRCA1 (40%) BRCA2 (18%) >50yo Nulliparity Delayed pregnancy FHx of breast or ovarian cancer
Ovarian cancer often presents early with red flag symptoms. True/False?
False
Prevents late with non-specific symptoms (60%)
List some non-specific clinical features of ovarian cancer
Ascites/persistent bloating Pelvic mass, pelvic/abdominal pain Bladder dysfunction Pleural effusion Breathlessness Difficulty eating, feeling full quickly
Ovarian cancer can commonly be asymptomatic. True/False?
False
Rarely asymptomatic with almost always abdominal bloating/distention
What is the BEAT acronym to help raise awareness for ovarian cancer?
Bloating
Eating less, feeling full
Abdominal pain
Tell GP!
How is ovarian cancer screened for?
It isn’t!
High-risk women are identified and investigated, though
What should we offer women with BRCA mutations?
Prophylactic oophorectomy and removal of fallopian tubes
What marker is used in the diagnosis of ovarian cancer?
CA 125
Raised CA 125 alone is enough to diagnose ovarian cancer. True/False?
False
Can be raised in other things (e.g. endometriosis) so need ultrasound, cytology of fluid as well
What is the gold standard investigation for diagnosing ovarian cancer?
Pathology specimen from CT-guided biopsy or laparoscopic biopsy
State the calculation for “risk of malignancy index” for ovarian cancer
Ultrasound score x menopausal score x CA125 level
How many points on the “risk of malignancy index” for ovarian cancer is enough to refer to secondary care?
Score greater than 200
What are the ultrasound features looked out for in ovarian cancer that are involved in the “risk of malignancy index”?
Multilocular cysts Solid areas Bilateral lesions Ascites Intra-abdominal mass
What are the main methods of metastases of ovarian cancer?
Transcoelomic spread (peritoneal)
Haematogenous (liver, lungs, brain if late)
Lymphatic
List the main treatment options for ovarian cancer
Surgery
Chemotherapy + surgery
In women with low-grade ovarian cancer, optimal surgical staging should be done by doing what?
Biopsies of peritoneal lesions
Infracolic omentectomy
Iliac, para-aortic lymph node sampling
In advanced ovarian cancer, what should be given prior to surgery?
Neoadjuvant chemotherapy
What are the main chemotherapy agents used for ovarian cancer?
Carboplatin (1st line)
Paclitaxel (more side-effects)
What chemotherapy should be offered in those with relapsing platinum-sensitive ovarian cancer?
Platinum-based combination with paclitaxel, PLDH or gemcitabine
What therapy can be used for platinum-resistant ovarian cancer?
Hormonal therapy (tamoxifen, letrozole)
In the absence of symptoms, should CA125 levels be measured during followup for ovarian cancer?
Not routinely monitored as won’t benefit with early chemotherapy
Epithelial cell tumours usually occurs in what age group?
Older women
50-70s
Germ cell and sex cord tumours usually occur in what age group?
Younger women
30s-50s
What is the first-line treatment for 1A/1B stage disease?
Comprehensive surgical staging
What is the first-line treatment for 1C stage disease?
Comprehensive surgical staging + chemotherapy
What is the first-line treatment for stage II,III or IV stage disease?
IV chemotherapy (platinum sensitive or platinum resistant)
