Ovarian cancer

Question 1

What is the peak incidence of ovarian cancer and prognosis?

Answer 1

75-84

Poor prognosis as it presents late with vague symptoms and insidious onset

Question 2

What is the aetiology of ovarian cancer?

Answer 2

Fallopian tubes if often sit of origin
BRCA1 has risk of 46% by 70
BRCA2 has risk of 12% by 70

Question 3

What are risk factors for ovarian cancer?

Answer 3

Many ovulations:
Nulliparity
Early menarche
Lat menopause 
Family history:
BRCA1, BRCA2
Hereditary NonPolyposis Colorectal Carcinoma

Question 4

What are protective factors for ovarian cancer?

Answer 4

Pregnancy
Breastfeeding
COCP
Tubal ligation (female sterilisation)

Question 5

When should you refer for clinical genetics?

Answer 5

Two primary cancers in on 1st or 2nd degree relative
Three 1st or 2nd degree relatives with breast, ovary, colorectal, stomach or endomrial cancers
Two 1st or 2nd degree relatives, on with ovarian cancer at any age, the other with breast cancer <50 years
Two 1st or 2nd degree relatives with ovarian cancer at any age

Question 6

What are clinical features of ovarian cancer?

Answer 6

Vague symptoms
Abdominal distension and bloating
Unexplained weight loos
Loss of appetite
Early satiety
Fatigue
Urinary symptoms e.g. frequency and urgency
Change in bowel habit
Abdominal and pelvic pain
Vaginal bleeding
Pelvic mass palpable

Question 7

What investigations for ovarian cancer?

Answer 7

FBC U&E LFT
CA125 tumour marker (endometriosis, menstruation, benign ovarian cysts may raise CA125)
Urgent USS of abdomen and pelvis if CA125 is raised

CT abdomen/pelvis to detect peritoneal disease and metastases

Question 8

What are stages of ovarian cancer?

Answer 8

FIGO staging

I - limited to one or both ovaries (Ic if capsule is breached or tumour is present on surface or peritoneal washings positive)
II - limited to the pelvis
III - limited to abdomen including regional lymph node metastasis
IV - Distant metastasis outside abdominal cavity

Question 9

What is management of ovarian cancer?

Answer 9

Full staging laparotomy through midline incision
Remove tumour
Midline laparotomy
Hysterectomy
Bilateral salpingo-oophorectomy
Omentectomy
Para-aortic and pelvic lymph node sampling
Pertinoeal washing and biopsies

Stage III/IV cancers use neoadjuvant chemotherapy

Chemotherapy:
Platainum agents
Carboplatin with paclitaxel

Question 10

What are borderline ovarian tumours?

Answer 10

Epithelial and not benign
More common in younger women
Confinement to one ovary
Pre-menopausal age group
Metastatic implants
Difficulty in diagnosing histologically and with a much better prognosis that ovarian cancer

Treat with
Unilateral oophorectomy and staging biopsy

Question 11

What is pseudomyxoma peritonei?

Answer 11

Arise from primary tumour of appendix

Thick jelly like deposits throughout abdomen

Question 12

What is the tumour marker for ovarian cancer?

Answer 12

CA125