Ovarian Cancer

Question 1

ovarian cancer

Answer 1

• worst of all reprod cancers
• has silent growth (asympt)
• when detected, prognosis is poor; difficult to dx (75% mets at dx)
• gametes within ovaries continually divide

Question 2

expand more on gametes in the ovaries

Answer 2

• with CA, proliferation > regular oogenesis
• ovary enlarges d/t excessive proliferation
• mnftns only appear once ovaries grow large enough to impact other organs

Question 3

etiology and risk

Answer 3

• gene mutation of oncogenes
• some inherited forms (autosomal dominant)
• ageing (65-85 yrs)
• familial risk (applies to breast CA, can be linked with ovarian CA)
• infertility (nulliparity - ovarian cycle not broken)

Question 4

what are the risk factors under ageing?

Answer 4

• unsuppressed cycles
• ovulatory age (duration of unsuppressed cycles) -> repetitive cycles that aren’t broken increase risk for developing the CA

Question 5

patho

Answer 5

• 3 forms of CA:
  
  1. Epithelial
  2. Germ Cell
  3. Stromal
• silent growth, spread and progression = late manifestations
  spread by extension -> tubes, uterus, other ovary
  seeding -> liver, bowel
  true mets -> liver, bone, brain (via blood and lymph)
• in most cases, detection is through abd distention and pressure on adjacent structures (brought about by ascites)
• no uniform appearance (varied forms)
• papillations

Question 6

papillations

Answer 6

scattered tumor growth

Question 7

epithelial form of CA

Answer 7

• tissue lines ovary (simple squamous and cuboidal epithelium)
• 90% of ovarian CA arises here

Question 8

germ cell form of CA

Answer 8

underneath this lies dense CT called the tunica albuginea

Question 9

stromal form of CA

Answer 9

• CT of cortical region where ovarian follicles are embedded (that contain oocytes)
• stroma contain spindle-shaped fibroblasts that respond to hormonal stimuli

Question 10

manifestations

Answer 10

• early symptoms = nonspecific GI disturbances
• urinary and bowel obstr d/t pressure on bowel
• pain
• abd distention
• ascites and dyspnea
• pelvic mass (1st but late finding)

Question 11

non-specific GI disturbances

Answer 11

difficult to detect

abd discomfort, flatulence, bloating

Question 12

why does ascites and dyspnea occur?

Answer 12

damage to cells and inflmtn causes 3rd spacing, leading to ascites which impacts the diaphragm and impedes lung expansion = difficulty breathing

Question 13

diagnosis

Answer 13

• pelvic exam
• transvaginal US
• laparascopy
• labs
• CA 125

Question 14

CA 125

Answer 14

• cancer antigen 125
• serum marker, not a screen
• can be elevated physiologically (ie. during menstruation, PID)
• could be used as a potential screen in women who are at an increased risk
• used to monitor treatment

Question 15

treatment

Answer 15

• aggressive
• radical Sx (ovaries, uterus, tubes and omentum)
• chemo (for intermediate and advanced disease)
• repeat laparascopy (to determine if further tx is needed)
• full recovery is possible