Ovarian Cancer Flashcards
1
Q
How common is ovarian cancer?
A
It is the fourth most common cancer in the UK
2
Q
What % of deaths in women aged 40-60 years does ovarian cancer account for?
A
5%
3
Q
What is the average age of presentation of ovarian cancer?
A
60 years
4
Q
What other cancers can share histological features with ovarian cancer?
A
Fallopian tube and peritoneal cancer
5
Q
How is the management of fallopian tube and peritoneal cancer similar to that of ovarian cancer?
A
They are treated with a similar approach
6
Q
What appears to protect against the development of ovarian cancer?
A
Suppressed ovulation
7
Q
Give two examples of things that suppress ovulation
A
- Prolonged breastfeeding
- High-oestrogen OCP
8
Q
What % of women with ovarian cancer have a positive family history?
A
Up to 7%
9
Q
What is the risk of ovarian cancer in patients with Peutz-Jeghers syndrome?
A
10%
10
Q
What are the well recognised familial patterns occur in ovarian cancer?
A
- Hereditary breast/ovarian cancer families
- Lynch type II families
11
Q
What mutations do hereditary breast/ovarian cancer families have?
A
BRCA1 or BRCA2
12
Q
What cancers are lynch type II families at increase risk of of?
A
- Ovarian
- Endometrial
- Colorectal
- Gastric
13
Q
What mutations do lynch type II families have?
A
Mutations in mismatch repair enzymes
14
Q
What kind of cancer is most common in the ovary?
A
Epithelial tumours
15
Q
What % of ovarian cancers are epithelial tumours?
A
90%
16
Q
What histological class of cancer do epithelial ovarian tumours include?
A
Adenocarcinomas
17
Q
What are the potential histological appearances of adenocarcinomas of the ovary?
A
- Serous
- Mucinous
- Endometrioid
- Clear cell
- Squamous cell
18
Q
What are the other, rarer types of ovarian tumours?
A
- Germ cell tumours
- Carcinosarcomas
- Sex cord tumours
19
Q
In what ways to ovarian germ cell tumours resemble testicular germ cell tumours?
A
In histology and clinical management
20
Q
What are the features of carcinosarcomas?
A
- Aggressive
- More susceptible to haematogenous spread
21
Q
What kinds of tumours does ovarian sex cord tumours include?
A
- Granulosa cell tumours
- Thecomas
- Sertoli-Leydig cell tumours
- Gonadoblastomas
22
Q
What do sex cord ovarian tumours occasionally produce?
A
- Oestrogens
- Androgens
23
Q
What can oestrogens produced by sex cord ovarian tumours cause?
A
- Precocious puberty
- Postmenopausal bleeding
24
Q
What can androgens produced by sex cord ovarian tumours cause?
A
Virilisation
25
What are the symptoms of early stage ovarian cancer?
Asymptomatic in the majority of cases
26
When do most women with ovarian cancer present?
When they have advanced disease
27
What are the symptoms of advanced ovarian cancer?
- Vague abdominal discomfort
- Bloating
- Altered bowel habit
- Nausea and vomiting
- Backache
- Weight loss
28
What % of women with ovarian cancer present with advanced disease that is stage 3-4?
70%
29
Can ovarian cancer cause vaginal bleeding?
It is uncommon, and more likely to be Fallopian tube cancer
30
When is it important to consider and exclude ovarian cancer?
In a woman presenting with recent chance in bowel habit, or with vague abdominal symptoms
31
What systemic presentations of ovarian cancer are associated with more advanced disease?
- Pleural effusions
- Ascites
- Malignant bowel obstruction
- Thromboembolic phenomenon
32
How are umbilical peritoneal deposits from ovarian cancer metastasis sometimes seen?
As Sister Mary Joseph nodules
33
What are Sister Mary Joseph nodules?
Palpable nodules bulging from the umbilicus
34
What does the presence of Sister Mary Joseph nodules?
Indicates transcoelomic spread and stage 4 disease
35
What lymph nodes should be checked in ovarian cancer?
- Neck
- Supraclavicular
- Axillary
- Inguinal
- Para-aortic
36
What should be looked for on cardiovascular examination in ovarian cancer?
- Pericardial effusion
| - Loud P2
37
What might cause loud P2 on cardiovascular examination in ovarian cancer?
Pulmonary hypertension or PE
38
What should be looked for on general observation in ovarian cancer?
- Viralisation
- Ascites
- Cachexia
- Signs of dehydration
39
What should be looked for on skin examination in ovarian cancer?
Dermatomyositis
40
What should be looked for on genitourinary examination in ovarian cancer?
- Haematuria
| - PV discharge/bleeding
41
What should be looked for on respiratory examination in ovarian cancer?
- Pleural effusion
- Pleural rub
- Tachypnoea
42
What might cause pleural rub or tachypnoea on respiratory examination in ovarian cancer?
PE
43
What should be looked for on abdominal examination in ovarian cancer?
- Surgical scars
- Umbilical nodules
- Visible peristalsis
- Bowel obstruction
- Abdominal distention
- Ascites
- Hepatomegaly
- Hepatic tenderness
- Renal tenderness
- Pelvic mass
- Adenexal mass
44
What should be looked for on neurological examination in ovarian cancer?
- Focal neurological signs
| - Cerebellar dysfunction
45
Are focal neurological signs common in ovarian cancer?
No, they are rare
46
What can cause cerebellar dysfunction in ovarian cancer?
Paraneoplastic syndromes
47
What should be looked for on skeletal examination in ovarian cancer?
Focal bone tenderness
48
What should be looked for on peripheral examination in ovarian cancer?
Calf tenderness
49
What may calf tenderness indicate in ovarian cancer?
DVT
50
What staging system can be used for ovarian cancer?
FIGO staging system
51
What is a stage 1a ovarian cancer?
Tumour confined to one ovary
52
What is a stage 1b ovarian cancer?
Tumour involving both ovaries, but no serosal involvement
53
What is a stage 1c ovarian cancer?
Tumour that has one of the following features;
- On the ovarian surface
- Capsular breach or rupture
- Malignant ascites
54
What is stage 2a ovarian cancer?
Tumour has extended and/or implanted into the uterus and/or fallopian tubes.
Malignant cells are not detected in ascites or peritoneal washings
55
What is stage 2b ovarian cancer?
Tumour that has extended to another organ in the pelvis.
| Malignant cells are not detected in ascites or peritoneal washings
56
What is stage 2c ovarian cancer?
Tumours that are stage 2a or b, but malignant cells are detected in the ascites or peritoneal washings
57
What is stage 3a ovarian cancer?
Microscopic peritoneal metastasis beyond the pelvis.
| No lymph node involvement
58
What is stage 3b ovarian cancer?
Macroscopic peritoneal metastasis beyond the pelvis, but <2cm in greatest dimension
59
What is stage 3c ovarian cancer?
Macroscopic peritoneal metastasis beyond the pelvis >2cm in greatest dimension, and/or regional lymph node metastasis
60
What is stage 4 ovarian cancer?
Distant metastasis or parenchymal liver or other visceral metastasis, or malignant pleural effusion
61
What investigations can be used to differentiate between benign ovarian cysts and ovarian malignancy?
- Transvaginal ultrasound
- Serum CA125
- Age
62
What is the sensitivity and specificity of investigations to differentiate between benign ovarian cysts and ovarian malignancy?
80-90%
63
What additional use have transvaginal ultrasound and serum CA125 been studied for?
Population screening
64
What might CT imaging be useful for in ovarian cancer?
To detect abdominal spread, including liver, lung, pleura, and lymph node involvementd
65
How is the stage and extent of spread of ovarian cancer determined in ovarian cancer?
Surgery and the FIGO staging system
66
What is the first line intervention for people with ovarian cancer?
Surgery
67
What is the intention of surgery in ovarian cancer?
Debulking the disease
68
What are the potential outcomes of debulking surgery in ovarian cancer?
- Complete
- Optimal
- Suboptimal
69
What is meant by complete debulking in ovarian cancer?
No macroscopic disease
70
What is meant by optimal debulking in ovarian cancer?
Macroscopic disease <1cm
71
What is meant by suboptimal debulking in ovarian cancer?
Residual disease >1cm
72
What does surgery for ovarian cancer involve?
- Laparotomy
- Total hysterectomy
- Bilateral salpingo-oophrectomy with omentectomy and lymph node resection
73
What will the majority of women be candidates for after surgery for ovarian cancer?
Adjuvant chemotherapy
74
What chemotherapy agents are used for adjuvant chemotherapy in ovarian cancer?
- Carboplatin
| - Paclitaxel
75
What chemotherapy agent is added for adjuvant chemotherapy in patients with high risk ovarian cancer?
Bevacizumab
76
What is neoadjuvant chemotherapy used for in ovarian cancer?
Patients with extensive disease at presentation
77
What is the aim of neoadjuvant chemotherapy in ovarian cancer?
Shrink disease in order to consider interval debulking
78
What treatment does non-epithelial ovarian cancer require?
Surgery following by chemotherapy
79
What is the agent used for chemotherapy in non-epithelial ovarian cancer based on?
The predominant cell type present
80
What % of patients diagnosed with ovarian cancer achieve remission?
80%
81
What response rate is second-line chemotherapy associated with for relapse of ovarian cancer?
20-40%
82
What are higher response rates to second-line chemotherapy in relapsed ovarian cancer associated with?
Greater treatment-free intervals
83
What can serum CA125 be useful for in ovarian cancer?
- Predicting relapse
| - Predicting response to treatment
84
How far ahead can CA125 predict relapse?
4.2 months
85
Does early treatment of ovarian cancer based on CA125 levels alone give a survival advantage?
No
86
What % of patients with ovarian cancer will relapse at some point?
Approx 60%
87
What hormonal agents can be used in ovarian cancer?
- Tamoxifen
| - Aromatase inhibitors
88
What is the use of hormonal approaches in ovarian cancer?
They can slow down the rate of progression, and delay onset of symptoms
89
How will advanced ovarian cancer spread?
In a transcoelomic matter
90
What may transcoelomic spread of ovarian cancer produce?
- Ascites
| - Subacute or complete bowel obstruction
91
Why may transcoelomic spread of ovarian cancer produce bowel obstruction?
Due to serosal involvement of the bowel
92
What might a pelvic mass caused by ovarian cancer lead to?
Hydronephrosis due to ureteric obstruction
93
What might ascites caused by ovarian cancer require?
Frequent paracentesis
94
What can be used to reduce the recurrence of pleural effusions caused by ovarian cancer?
Talc pleurodesis
95
Why are patients with ovarian cancer at a particularly high risk of thrombosis?
Due to a prothrombotic tendency that correlates with disease activity
96
What does the prognosis of ovarian cancer correlate with?
Stage at diagnosis
97
What is the overall 5 year survival rate of ovarian cancer?
30%
98
What is the 5 year survival rate of stage 1 ovarian cancer?
>90%
99
What is the 5 year survival rate of stage 4 ovarian cancer?
<25%
100
What patients with ovarian cancer have a worse outcome?
- Disease resistant to platinum therapy
- Large volume residual disease following debulking
- Clear cell histology
101
What effect does having the BRCA mutation have on ovarian cancer prognosis?
They are more likely to have visceral metastasis, but are more likely to respond to platinum therapy, and have longer treatment-free interval
102
What is the best predictor outcome of ovarian cancer?
Achieving complete cytoreduction at initial surgery
