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Reproductive - Post-Menopause > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

1
Q

What is the typical presentation of ovarian cancer?

What is the median age of diagnosis?

What may be present on examination?

A

An insidious onset of non-specific symptoms

60

Ascites, pleural effusions, palpable pelvic mass

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2
Q

What are some examples of symptoms that ovarian cancer might present with?

A

Abdominal bloating

Eating less and feeling fuller

Abdominal pain

Fluctuating bowel habit

Bladder dysfunction

SOB (due to pleural effusion)

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3
Q

What are the 3 main types of ovarian cancer?

Which is the most common?

A

Epithelial - most common

Germ cell

Sex cord stromal cell

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4
Q

What are the 5 types of ovarian epithelial cancer?

Which is the most common?

A

Serous - most common

Clear cell

Mucinous

Endometrioid

Transitional cell

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5
Q

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?

A

Low = serous borderline tumour

High = serous tubal intra-epithelial carcinoma

CA125

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6
Q

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?

A

Serous

Endometrioid and clear cell

Transitional cell

Endometrial

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7
Q

What are the 3 main types of ovarian germ cell tumours?

A

Choriocarcinoma

Dysgerminoma

Immature teratoma

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8
Q

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

A rare, placental trophoblastic tumour - raised hCG

Dysgerminoma - raised hCG and AFP, almost exclusively in children and young women (mean of 22)

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9
Q

What is a granulosa cell tumour? What does it produce?

How may it present?

What chemical may be raised?

A

A slow growing tumour which produces oestrogen

Irregular or heavy bleeding, precocious puberty in younger girls

Inhibin

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10
Q

What hormones does a Sertoli cell ovarian tumour produce?

What clinical picture does this cause?

A

Androgens and testosterone

Progressive defeminisation and masculination

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11
Q

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?

A

Breast, pancreas, GI primaries

Tumours are small and bilateral

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12
Q

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?

A

BRCA mutations and Lynch Syndrome

Autosomal dominant

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13
Q

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?

A

Prophylactic bilateral salpingo-oophorectomy

Hormone replacement

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14
Q

What are the 3 main stages of investigation for ovarian cancer?

A

Blood tests

Imaging

Histopathology for staging

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15
Q

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?

A

CA125

CEA - rule out metastases from a GI primary

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16
Q

What are the main stages of imaging investigation for suspected ovarian cancer?

A

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

17
Q

What are the two main options for obtaining tissue for histopathology in ovarian cancer?

What is another sample that can be taken if present?

A

CT guided biopsy of an omental deposit OR laparoscopic biopsy of an abnormal ovary

Cytology from ascitic or pleural fluid

18
Q

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?

A

Refer to secondary care

RMI Score

19
Q

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?

A

US features, menopausal status and CA125

Ultrasound score x menopause score x CA125

> 200 = refer to gynae-oncology MDT

20
Q

What is meant by FIGO stage I ovarian cancer?

What is meant by FIGO stage II ovarian cancer?

A

IA = confined to one ovary, IB = confined to two ovaries

Tumour extends into other pelvic organs

21
Q

What is meant by FIGO stage III ovarian cancer?

What is meant by FIGO stage IV ovarian cancer?

A

Tumour extends into peritoneal surfaces outside the pelvis and/or involves lymph nodes

Distant metastases

22
Q

What is the worry about ovarian cancer and spread?

Where can it spread to haematogenously?

A

It can cause early trans-peritoneal spread

Liver, lung and very rarely brain

23
Q

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?

A

Surgery

Retroperitoneal lymph node sampling

If the tumour is confined to one ovary with no omental or peritoneal disease

Adjuvant chemotherapy

24
Q

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?

A

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

25
Q

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?

A

Single agent carboplatin

Post-surgery treatment

No

Doxorubicin or gemcitabine

26
Q

What can be used as a treatment for relapsed disease in women who are platinum resistant or if they wish to avoid more chemotherapy?

A

Hormone therapy with tamoxifen or letrozole

27
Q

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?

A

Nephrotoxicity, peripheral neuropathy, vomiting

Hair loss, neurotoxicity

Myelosuppression

28
Q

Should blood tests and scans be used in the follow up of ovarian cancer?

What is the role of chemotherapy following relapse?

A

Not if the patient is asymptomatic

Palliative - only use if symptomatic

Reproductive - Post-Menopause (7 decks)

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