Ovarian Cancer Flashcards
What is the typical presentation of ovarian cancer?
What is the median age of diagnosis?
What may be present on examination?
An insidious onset of non-specific symptoms
60
Ascites, pleural effusions, palpable pelvic mass
What are some examples of symptoms that ovarian cancer might present with?
Abdominal bloating
Eating less and feeling fuller
Abdominal pain
Fluctuating bowel habit
Bladder dysfunction
SOB (due to pleural effusion)
What are the 3 main types of ovarian cancer?
Which is the most common?
Epithelial - most common
Germ cell
Sex cord stromal cell
What are the 5 types of ovarian epithelial cancer?
Which is the most common?
Serous - most common
Clear cell
Mucinous
Endometrioid
Transitional cell
Serous ovarian carcinomas can be high or low grade, what are the precursor lesions for each of these?
What tumour marker is increased in > 90% of advanced cases of these tumours?
Low = serous borderline tumour
High = serous tubal intra-epithelial carcinoma
CA125
Which type of epithelial ovarian cancer is most associated with BRCA mutations?
Which types of epithelial ovarian cancer are most associated with endometriosis?
Which type of epithelial ovarian cancer can be known as a Brenner tumour and is far more likely to be benign?
40% of endometrioid ovarian cancers co-exist with which other cancer?
Serous
Endometrioid and clear cell
Transitional cell
Endometrial
What are the 3 main types of ovarian germ cell tumours?
Choriocarcinoma
Dysgerminoma
Immature teratoma
What is a choriocarcinoma? What marker may be raised in these tumours?
What is the most common germ cell tumour of the ovary? What markers may be raised in these tumours? Who does this tumour almost exclusively occur in?
A rare, placental trophoblastic tumour - raised hCG
Dysgerminoma - raised hCG and AFP, almost exclusively in children and young women (mean of 22)
What is a granulosa cell tumour? What does it produce?
How may it present?
What chemical may be raised?
A slow growing tumour which produces oestrogen
Irregular or heavy bleeding, precocious puberty in younger girls
Inhibin
What hormones does a Sertoli cell ovarian tumour produce?
What clinical picture does this cause?
Androgens and testosterone
Progressive defeminisation and masculination
What are some cancers which may metastasise to the ovaries?
Mets should always be considered as a diagnosis of an ovarian mass, but especially when?
Breast, pancreas, GI primaries
Tumours are small and bilateral
Most ovarian cancers are sporadic, but hereditary components account for around 10-15%. What are some heriditary conditions which can increase risk of ovarian cancer?
How are they inherited?
BRCA mutations and Lynch Syndrome
Autosomal dominant
Women who are identified as having a high risk of ovarian cancer (due to genetic risk) can be offered what?
What should be used after this procedure until the time of natural menopause?
Prophylactic bilateral salpingo-oophorectomy
Hormone replacement
What are the 3 main stages of investigation for ovarian cancer?
Blood tests
Imaging
Histopathology for staging
What is the main tumour marker looked for by a blood test in the diagnosis of ovarian cancer?
What is another you can use? What is this mainly used for?
CA125
CEA - rule out metastases from a GI primary
What are the main stages of imaging investigation for suspected ovarian cancer?
Transvaginal US to assess the pelvic mass
CT thorax/abdo/pelvis or MRI to assess the size of the mass and any extra-ovarian spread
What are the two main options for obtaining tissue for histopathology in ovarian cancer?
What is another sample that can be taken if present?
CT guided biopsy of an omental deposit OR laparoscopic biopsy of an abnormal ovary
Cytology from ascitic or pleural fluid
If a woman has persistent signs and symptoms of ovarian cancer but a negative CA125 and TVUS what should you do?
What score will then be calculated?
Refer to secondary care
RMI Score
What are the features that are counted for on an RMI score?
How is the score calculated?
What is the cut off score and what happens if a patient reaches this?
US features, menopausal status and CA125
Ultrasound score x menopause score x CA125
> 200 = refer to gynae-oncology MDT
What is meant by FIGO stage I ovarian cancer?
What is meant by FIGO stage II ovarian cancer?
IA = confined to one ovary, IB = confined to two ovaries
Tumour extends into other pelvic organs
What is meant by FIGO stage III ovarian cancer?
What is meant by FIGO stage IV ovarian cancer?
Tumour extends into peritoneal surfaces outside the pelvis and/or involves lymph nodes
Distant metastases
What is the worry about ovarian cancer and spread?
Where can it spread to haematogenously?
It can cause early trans-peritoneal spread
Liver, lung and very rarely brain
What is the main management of early stage ovarian cancer?
What should be considered as part of this management for staging?
Fertility can be conserved if what criteria are met?
All women with high grade, early stage disease should also be considered for what treatment?
Surgery
Retroperitoneal lymph node sampling
If the tumour is confined to one ovary with no omental or peritoneal disease
Adjuvant chemotherapy
What is the main management of more advanced disease ovarian cancer?
What chemotherapy agent is first line?
Ideally, what is the first line course of chemotherapy treatment?
Debulking surgery with either neo-adjuvant or adjuvant chemotherapy
A platinum agent, either in combination or as a single agent
3 weekly paclitaxel and carboplatin
Patients undergoing chemotherapy for ovarian cancer who are unfit for combination therapy should be offered what?
When is paclitaxel recommended to be used alongside carboplatin?
Should a third cytotoxic agent be added to carboplatin and paclitaxel?
In those unable to tolerate paclitaxel, what are some other options?
Single agent carboplatin
Post-surgery treatment
No
Doxorubicin or gemcitabine
What can be used as a treatment for relapsed disease in women who are platinum resistant or if they wish to avoid more chemotherapy?
Hormone therapy with tamoxifen or letrozole
What are some side effects of carboplatin?
What are some side effects of paclitaxel?
What is a side effect which is common to them both?
Nephrotoxicity, peripheral neuropathy, vomiting
Hair loss, neurotoxicity
Myelosuppression
Should blood tests and scans be used in the follow up of ovarian cancer?
What is the role of chemotherapy following relapse?
Not if the patient is asymptomatic
Palliative - only use if symptomatic
