Ovarian cancer

Question 1

How many new cases of ovarian cancer in Scotland per year?

Answer 1

600 cases per year

Question 2

How many deaths from ovarian cancer in Scotland per year?

Answer 2

400 deaths per year

23.8 per 100,000 women

Question 3

What is the 5 year survival of ovarian cancer (any stage)?

Answer 3

30%

Question 4

What age do you not expect ovarian cancer?

Answer 4

<30 years old rare as more common within postmenopausal woman (60-70 years old)

Question 5

How many cases of ovarian cancer are familial?

Answer 5

5-10% of cases

Question 6

What are the causes of familial cases of ovarian cancer?

Answer 6

• HNPCC/Lynch type II familial cancer syndrome
• BRAC 1 mutation
• BRAC 2 mutation

Question 7

What can the BRAC 1 mutation often lead to?

Answer 7

Increased risk for serous carcinoma of the ovary and Fallopian tubes as well as the breasts.

Question 8

When someone has a BRAC 1 mutation what is often performed?

Answer 8

1) Prophylactic salpingo-oophorectomy

2) Prophylactic mastectomy

Question 9

What symptoms are there for ovarian cancer symptoms?

Answer 9

> Vague

> Indigestion/early satiety/poor appetite

> Altered bowel habit/pain

> Bloating/discomfort/weight gain

> Pelvic mass

• Asymptomatic
• Pressure symptoms

Question 10

How is ovarian cancer diagnosed?

Answer 10

> Biopsy

> US Scan of abdomen and pelvis

> CT scan

> CA 125, although better for monitoring treatment response and reoccurrence

> Surgery

Question 11

What is CA 125?

Answer 11

Glyco-protein antigen

Question 12

What may lead to a rise in CA 125?

Answer 12

1) Malignancy:
- Ovary
- Colon
- Pancreas
- Breast

2) Benign conditions:
- Menstruation
- Endometriosis
- Pelvic inflammatory disease
- Liver disease/Recent surgery/Effusions

Question 13

Which three things combined give a big indication of ovarian cancer?

Answer 13

RMI = U x M x CA 125

1) US features:
- Multi-locular
- Solid areas
- Bilateral
- Ascites
- Intra-abdominal

2) Menopausal status
3) CA 125 levels

Question 14

Ulta-sound features of ovarian cancer?

Answer 14

US features:

• Multi-locular
• Solid areas
• Bilateral
• Ascites
• Intra-abdominal

Question 15

Ovarian cancer staging - Stage 1?

Answer 15

Limited to ovaries with capsule intact - cytology

Question 16

Ovarian cancer staging - Stage 2?

Answer 16

One or both ovaries with pelvic extension

Question 17

Ovarian cancer staging - Stage 3?

Answer 17

One or both ovaries with peritoneal implants outside pelvis or +nodes

Question 18

Ovarian cancer staging - Stage 4?

Answer 18

Distant metastasis

Question 19

Ovarian cancer treatment?

Answer 19

1) Surgery (Laparotomy)

2) Chemotherapy
- Adjuvant
- Neo-adjuvant

Question 20

What is the role of laparotomy in ovarian cancer?

Answer 20

1) Obtain tissue diagnosis
2) Stage disease
3) Disease clearance
4) Debulk disease

Question 21

What is the role of chemotherapy in ovarian cancer?

Answer 21

1) First line Platinum and taxane (Taxol)
2) Within 8 weeks of surgery
3) Complete/partial response
4) Cure unlikely
5) Average response 2 years

Question 22

What is the cure rate of ovarian cancer - Stage 1?

Answer 22

85%

Question 23

What is the cure rate of ovarian cancer - Stage 2?

Answer 23

47%

Question 24

What is the cure rate of ovarian cancer - Stage 3?

Answer 24

15%

Question 25

What is the cure rate of ovarian cancer - Stage 4?

Answer 25

10%

Question 26

What is the recurrence treatment plan for ovarian cancer?

Answer 26

1) Chemotherapy
2) Palliation
3) Platinum if <6months
4) Surgery
5) Tamoxifen

Question 27

When is screening used in ovarian cancer?

Answer 27

High risk women:

• Cancer gene mutation carriers
• 2 or more relatives

Question 28

Which investigations would you want to use in ovarian cancer screening?

Answer 28

1) Pelvic examination
2) US scanning of ovaries
3) CA 125

Question 29

Why is surgery used within ovarian cancer?

Answer 29

1) To stage

2) To reduce disease bulk

Question 30

Which stage of cancer does ovarian cancer present?

Answer 30

Stages 3 and 4