Ovarian Cancer Flashcards
Some people are at a higher genetic risk of developing ovarian cancer, who are these groups?[2]
HNPCC/ Lynch Type II Familial cancer syndrome
BRCA 1 and BRCA 2 (TSGs)
- 15-45% lifetime risk of Ovarian Cancer, early onset of breast and ovarian
Risk factors of ovarian cancer other than genetic factors [4]
Incessant ovulation hypothesis Asbestos exposure Endometriosis Diabetes, PCOS Unopposed estrogen
How does Ovarian Cancer present? [5]
Age
Very vague symptoms
Indigestion, early satiety, poor appetite
Altered bowel habit/pain
Bloating, discomfort, weight gain
Pelvic mass - asymptomatic or pressure symptoms
PV bleeding
Age <30yo
Ovarian cancer investigations? [5]
Start with an abdo > pelvic US
US guided biopsy of omentum to obtain needle cores
CT staging
Tumor markers: CA125 if >40yo, AFP LDH HCG if <40yo
Laparospic exploration
What is CA 125? [2]
Elevated in other cancers [4]
Benign conditions with elevated CA125 [3]
A serum biomarker that is a glycoprotein antigen Elevated in other cancers: Endometrial ca, fallopian tube ca Breast ca Lung ca GI cancer
Benign conditions with elevated CA125:
Any pathology that irritates peritoneum
Menstruation, endometriosis, PID
Liver disease, recent surgery
Risk of malignancy index is used to estimate likelihood of individual having cancer: [3]
NB not diagnostic
With a risk of malignancy index (RMI): US x M x CA125
US - US features of malignancy [5]
M - Menopausal status - yes = 1, no = 3
What US features apply to the RMI? [5]
1 feature = 1point
2+ = 3 points
- Multi-locular
- Solid areas
- Bilateral
- Ascites
- Intra-abdominal
Whats an abnormal CA125?
> 200 is considered a significant risk
How is Ovarian cancer treated? [3]
Chemotherapy - first line drugs are platinum, taxane
Surgical removal - laporotomy
What if ovarian cancer recurs? [3]
2nd line chemo often palliative
Repeat surgery - where further resection would benefit patient, can build up chemotherapy reserve for chemo later on
Tamoxifen if cannot tolerate systemic chemotherapy ie if elderly
Ovarian cancer staging [4]
FIGO stages - pathology after surgery:
1 = Limited to ovaries with capsule intact
2 = One or both ovaries with pelvic extension
3 = One or both ovaries with peritoneal implants outside pelvis or positive nodes
4 = Distant mets
Who would we screen for ovarian cancer?
Only high risk women i.e.:
- Carrying BRCA genes or HNPCC
- 2+ relatives with OC
How do we screen for ovarian cancer? [3]
Pelvic exam, US, CA125
What can we do for very high risk women?
Prophylactic Oophorectomy once they’re done having family, usually around 40
MOA platinum based drugs
Give 3 eg of platinum based drugs
MOA taxanes [2]
Platinum based drugs MOA: form highly reactive platinum complexes that bind and crosslink DNA causing cancer cell apoptosis e.g. cisplatin, carboplatin, oxaliplatin
Taxanes - block cell cycle progression through centrosomal, impairment induction of abnormal spindles and suppression of spindle microtubule dynamics
Laporotomy as treatment for ovarian cancer - aims [4]
○ Removing all naked-eye diseases, disease clearance and debulking
○ Obtain tissue diagnosis
○ Stage disease
○ Disease clearance
Protective factors [4]
pregnancy, breastfeeding, COCP, tubal ligation
Signs of ovarian cancer [5]
Pelvic/abdominal mass Omental mass Ascites Pleural effusion Supraclavicular lymph node enlargement
Classification [3] Give 3 examples of each
Sex cord stromal ovarian cancer
- Granulosa theca cell
- Fibromas (Meig’s)
- Sertoli-Leydig cell
Germ cell ovarian cancer
- Teratomas eg struma ovarii
- Choriocarcinoma (placental tissue)
- Dysgermioma (oocyte tumor)
Epithelial ovarian cancer
- Serous
- Mucinous
- Endometrioma
- Transitional cell
Mucinous adenomas clinical features [4]
CA19.9
Large tumours
Appendix removed at same time
Associated with malignant pseudomyxoma peritonei
Meig’s syndrome triad [3]
Right sided ovarian fibroma
Pleural effusion
Ascites
Investigations of benign ovarian tumours [5]
FBC Tumour markers: BHCG, CA125, CA19.9 TVUSS TAUSS MRI
Management of pre-menopausal lady with pelvic mass
Re-scan in 6w Discharge: - No features of malignancy - Cyst <5cm Laparoscopic cystectomy: - If >5cm, symptomatic - Features of endometrioma or dermoid cyst
Management of post-menopausal lady with pelvic mass [4]
Calculate RMI, stratify her risk Low risk cysts <5cm: - Conservative mx with repeat TVUSS and CA125 every 4m Moderate risk cysts: - Bilateral oophorectomy High risk cysts: - Staging laparotomy
When would you discharge a post-menopausal lady with suspected benign ovarian tumors?
Discharge if no change on TVUSS and CA125 in 1 year
