Ovarian Cancer

Question 1

Epidemiology of ovarian cancer

Answer 1

70% are carcinoma of epithelial origin

Mortality rate is highest of all gynae d/2 rapid metastasis

Peak age: 40-60 years

Question 2

RF of ovarian cancers

Answer 2

Prolonged ovulation: early menarche, late menopause, nulliparity

Fam history in 1st degree relatives

Genetic; braca, HNPCC(Lynch),

Ionising radiation

Question 3

Development of ovarian cancer

Answer 3

Increased oncogene expression:
change in HER2/neu, cyc, ras

Change of tumor suppression genes
p53, braca1&2, dna mismatched repair

Germline mutations in braca1

Question 4

Histological types of malignant epithelial tumors

Answer 4

Serious 
Mucinous
Endometroid 
Squamous 
Clear cell
Brenner 

Can be unilateral/ bilateral

Types of differentiation (G) 
Gx: diff can’t be assessed 
Gb: borderline tumor 
G1: well diff 
G2: moderately diff 
G3: poor diff
G4: undiff

Question 5

How does ovarian cancer spread

Answer 5

Local: retroperitoneally by cell exfoliation in pelvis

Peritoneal carcinosis: intraperitoneal after rupture of the cancer

Lymphatic: paraaortic lymph nodes, inguinal and femoral LN

Henatogenous: liver, lung, CNS, rarely bone

Question 6

TNM staging of ovarian

Answer 6

T0
Tx
T1: limited to ovaries. 
A: intact capsule 
B: both ovaries intact capsule
C: ruptured capsule 
T2: extends into pelvis 
A: into uterus/ Fallopian tubes
B: invasion of other pelvic organs 
C: tumor cells in ascites in peritoneal lavage 
T3: beyond pelvis into peritoneum 
A: microscopic detection 
B: tumor size below 2cm 
C: tumor size above 2cm

Question 7

TNM staging

Answer 7

Stage 1:

Stage 2:

Stage 3:

Stage 4:

Question 8

Sx of ovarian cancer

Answer 8

Late stage discovery d/2 long asymptomatic period

Abdominal pain

Weight loss

Loss of appetite

Genital bleeding

Abnormal menstruation

Ileus, urinary frequency, pollakuria

Question 9

Dg of ovarian cancer

Answer 9

History

Gynaecological exam

Rectal exam

Lab tests: LDH, liver & renal function

Tumour markers: CA 125!! Up to 90% sensitivity for COURSES only not dg

Histological exam of ascites

NO FINE NEEDLE ASPIRATION increases spread

Invasive methods of low Malignancy is suspected

Imagining

• US: trans vag, abdominal
• CT
• preoperarivr cystoscopy

Question 10

Principles of rx of ovarian cancer

Answer 10

Surgery: therapeutic resection and staging

Early= radial surgery
-Hysterectomy, bilateral salpingoophorectomy
- biopsy of LN
Advanced = cytoreductive therapy or a tee neoadjuvant chemo

Chemo: platinum derived : cisplatin/carbaplatin

Early= adjuvant chemotherapy

Target therapy= relapse