Ovarian Cancer

Question 1

Ovarian Cancer?

Answer 1

• Normally gametes within ovaries continually divide. With cancer the proliferation is much greater than in regular oogenesis. Ovary enlarges d/t this excessive proliferation. Manifestations only appear once ovaries grow large enough to impact other organs.

Question 2

Is ovarian diagnosed early?

Answer 2

It is difficult to diagnose -> 75% mets on detection

Question 3

Etiology/risks of ovarian cancer?

Answer 3

• aging (between 65-85yrs is most common)
• Autosomal dominant
• Family hx of ovarian cancer
• Other factors: nulliparity, infertility

Question 4

What are the 3 types of ovarian cancer?

Answer 4

• epithelial
• germinal
• stromal

Question 5

Epithelial CA?

Answer 5

Epithelial tissue lines the ovary (simple squamous or cuboidal epithelium) - most common (adenocarcinoma)

Question 6

Germinal CA?

Answer 6

Underneath this lies dense CT called tunica albuginea

Question 7

Stromal CA?

Answer 7

Stromal tissue, the connective tissue of the cortical region, where the ovarian follicles are embedded (that contain the oocytes)
- stroma contains spindle-shaped fibroblasts that respond to hormonal stimuli

Question 8

Is ovarian CA easily detected?

Answer 8

NO, ovarian cancer has a silent growth and spread (late manifestations and can spread through seeding)

Question 9

What kind of spread is there in ovarian cancer?

Answer 9

• spread by extension; seeding; true metastases

Question 10

Where does ovarian cancer spread to by extension?

Answer 10

• tubes, uterus, ligaments, other ovary

Question 11

Where does seeding occur in ovarian cancer?

Answer 11

bowel surfaces, liver & other organs {pressure applied on adjacent organs or abdominal distention}

Question 12

Where does true metastases in ovarian cancer occur?

Answer 12

liver, bone, brain {via. lymph and blood}

Question 13

What structural changes occur in ovarian cancer?

Answer 13

papillations

Question 14

Manifestations of ovarian cancer?

Answer 14

• early symptoms: non-specific GI disturbances
• pain
• urinary and bowl obstructions d/t pressure on bowel
• abdominal distention if tumour is large enough
• damage to cells & inflammation -> third spacing -> ascites (impacts diaphragm and lung expansion -> dyspnea)
• pelvic mass (usually the first finding, once this can be felt it is already progressed)

Question 15

Dx for ovarian cancer?

Answer 15

• Pelvic exam
• Ultrasound, laparoscopy
• Serum Marker: CA125

Question 16

Treatment for ovarian cancer?

Answer 16

• Aggressive
• radical surgery (affected ovary, uterus, tubes, opposite ovary and omentum)
• then chemo
• repeat laparoscopy
• FULL RECOVERY IS POSSIBLE IF DETECTED EARLY

Question 17

What is a disadvantage of the serum marker Cancer antigen 125?

Answer 17

This marker can be elevated physiologically ex. during menstruation