Ovarian Cancer

Question 1

Prognosis

Answer 1

5YR SURVIVAL ALL STAGES = 30%

MOST PRESENT w/ ADVANCED DISEASE - STAGE 3/4 DISEASE

Question 2

Aetiology

Answer 2

MAINLY = likely originate from FALLOPIAN TUBES

SOME = derive from PRE-EXISTING BENIGN OVARIAN CYSTS (ofeten low grade cancers)

Question 3

Presentation

Answer 3

• VAGUE!
  
  • INDIGESTION/EARLY SATIETY/POOR APPETITE
  • ALTERED BOWEL HABIT/PAIN - pelvic/abdominal
  • BLOATING/DISCOMFORT/WGT. GAIN○ Can have similar symptoms to IBS - but IBS RARELY PRESENTS for 1ST in WOMEN of this AGE
  • PELVIC MASS = can have quite a big mass before it rises into the abdomen & becomes noticeable

    ○ ASYMPTOMATIC
    ○ PRESSURE SYMPTOMS

  • Sometimes URINARY SYMPTOMS

Question 4

Investigations

Answer 4

SURGICAL/PATHOLOGICAL

* PELVIC EXAM
* USS ABDOMEN & PELVIS
* CT SCAN

* CA 125
* SURGERY

Question 5

Management

Answer 5

• SURGERY + ADJUVANT CHEMOTHERAPY (gold standard) - neoadjuvant chemotherapy to shrink/remove small tumours

Laparotomy = OBTAIN TISSUE DIAGNOSIS + STAGE DISEASE + DISEASE CLEARANCE/DEBULK DISEASE

Chemotherapy = 1st line is platinum + taxane (taxol) w/I 8 weeks of surgery - complete/partial surgery, avg response if 2yrs - may have to re-challenge

Recurrence = chemotherapy (platinum if < 6 months), palliation, surgery in highly selective pt.

Question 6

Epidemiology/Risk Factors

Answer 6

• RARE < 30YRS
  
  • ≥ 50s
  • HIGH-RISK FAMILIES = 5 - 10% of cases - HNPCC/LYNCH TYPE II FAMILIAL CANCER, BRCA1, BRCA2

    ○ Tend to PRESENT DECADE EARLY ~ 40s - MID-40s

  • INCESSANT OVULATION
  • OCP PROTECTIVE

Question 7

Staging

Answer 7

1 = limited to ovaries w/ capsule intact

2 = 1/both ovaries w/ pelvic extension

3 = 1/both ovaries w/ omental disease/lymph node involvement

4 = distant metastasis

Question 8

Ovarian Cancer Screening

Answer 8

not recommended for normal pt. as low sensitivity + low specificity

high risk women = cancer gene mutation carriers/≥ 2 relatives = pelvic examination, USS ovaries, CA 125; can have prophylactic oophorectomy

Question 9

CA 125

Answer 9

detecting + monitoring epithelial ovarian tumours

benign = endometriosis, menstruation, PID, liver disease, recent surgey, effusions - raised in peritoneal inflammation

malignant = ovary, breast, colon/pancreas