Ovarian cancer Flashcards
How many new cases of ovarian cancer in Scotland per year?
600 cases per year
How many deaths from ovarian cancer in Scotland per year?
400 deaths per year
23.8 per 100,000 women
What is the 5 year survival of ovarian cancer (any stage)?
30%
What age do you not expect ovarian cancer?
<30 years old rare as more common within postmenopausal woman (60-70 years old)
How many cases of ovarian cancer are familial?
5-10% of cases
What are the causes of familial cases of ovarian cancer?
- HNPCC/Lynch type II familial cancer syndrome
- BRAC 1 mutation
- BRAC 2 mutation
What can the BRAC 1 mutation often lead to?
Increased risk for serous carcinoma of the ovary and Fallopian tubes as well as the breasts.
When someone has a BRAC 1 mutation what is often performed?
1) Prophylactic salpingo-oophorectomy
2) Prophylactic mastectomy
What symptoms are there for ovarian cancer symptoms?
> Vague
> Indigestion/early satiety/poor appetite
> Altered bowel habit/pain
> Bloating/discomfort/weight gain
> Pelvic mass
- Asymptomatic
- Pressure symptoms
How is ovarian cancer diagnosed?
> Biopsy
> US Scan of abdomen and pelvis
> CT scan
> CA 125, although better for monitoring treatment response and reoccurrence
> Surgery
What is CA 125?
Glyco-protein antigen
What may lead to a rise in CA 125?
1) Malignancy:
- Ovary
- Colon
- Pancreas
- Breast
2) Benign conditions:
- Menstruation
- Endometriosis
- Pelvic inflammatory disease
- Liver disease/Recent surgery/Effusions
Which three things combined give a big indication of ovarian cancer?
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
Ulta-sound features of ovarian cancer?
US features:
- Multi-locular
- Solid areas
- Bilateral
- Ascites
- Intra-abdominal
Ovarian cancer staging - Stage 1?
Limited to ovaries with capsule intact - cytology
Ovarian cancer staging - Stage 2?
One or both ovaries with pelvic extension
Ovarian cancer staging - Stage 3?
One or both ovaries with peritoneal implants outside pelvis or +nodes
Ovarian cancer staging - Stage 4?
Distant metastasis
Ovarian cancer treatment?
1) Surgery (Laparotomy)
2) Chemotherapy
- Adjuvant
- Neo-adjuvant
What is the role of laparotomy in ovarian cancer?
1) Obtain tissue diagnosis
2) Stage disease
3) Disease clearance
4) Debulk disease
What is the role of chemotherapy in ovarian cancer?
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
What is the cure rate of ovarian cancer - Stage 1?
85%
What is the cure rate of ovarian cancer - Stage 2?
47%
What is the cure rate of ovarian cancer - Stage 3?
15%
What is the cure rate of ovarian cancer - Stage 4?
10%
What is the recurrence treatment plan for ovarian cancer?
1) Chemotherapy
2) Palliation
3) Platinum if <6months
4) Surgery
5) Tamoxifen
When is screening used in ovarian cancer?
High risk women:
- Cancer gene mutation carriers
- 2 or more relatives
Which investigations would you want to use in ovarian cancer screening?
1) Pelvic examination
2) US scanning of ovaries
3) CA 125
Why is surgery used within ovarian cancer?
1) To stage
2) To reduce disease bulk
Which stage of cancer does ovarian cancer present?
Stages 3 and 4
