Ovarian Cancer

Question 1

From where does ovarian cancer arise?

Answer 1

Most actually arise from the fallopian tube

Some arise from benign ovarian cysts, these are generally lower grade cancers

Question 2

Some people are at a higher genetic risk of developing ovarian cancer, who dis?

Answer 2

• People in HNPCC families / lynch type II familial cancer syndrome
• Carriers of BRCA genes (BRAC 1 or 2)

Question 3

What are the BRCA genes?

Answer 3

Tumour suppressor genes

Certain mutations are passed on by Autosomal Dominant inheritence

Question 4

How much risk are BRCA 1 and 2 carriers at?

Answer 4

15-45% lifetime risk of Ovarian Cancer

Also develop Ovarian and breast very young

Question 5

What other things are risk factors for Ovarian Cancer?

Answer 5

• Being older
• Incessant ovulation (i.e. not using OCP or being pregnant)

Question 6

How does Ovarian Cancer present?

Answer 6

Very vague symptoms:

• Indigestion/poor appetite
• Altered bowel habit and pain
• Bloating, discomfort and weight gain
• Feeling a pelvic mass and pressure symptoms

Question 7

How do we test if we suspect ovarian cancer?

Answer 7

1. Start with an abdo and pelvic US
2. CT
3. CA 125 test (protein found in blood)
4. Surgery

Question 8

What is CA 125?

Answer 8

A serum biomarker raised in peritoneal damage e.g. ascites, endometriosis, PID, breast cancer, liver disease or ovarian cancer

• Glycoprotein antigen
• Not accurate screening test or a diagnostic test for ovarian cancer

Question 9

We can’t check directly for ovarian cancer from the outside so how to we assess the likelihood?

Answer 9

With a risk of malignancy index (RMI): US x M x CA125

• US features (US) of malignancy (M)
• Menopausal status

Question 10

What US featuers apply to the RMI?

Answer 10

1 feature = 1point 2+ = 3 points

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

Question 11

How do we score a woman’s menopausal status on RMI?

Answer 11

Pre-menopause = 1

Post-menopause = 3

Question 12

Whats an abnormal CA125?

Answer 12

>200 is considered a significant risk

Question 13

How is ovarian cancer treated?

Answer 13

Laparotomy with adjuvant/neo-adjuvant chemo

Question 14

What is ovarian cancer recurs?

Answer 14

1. 2nd line chemo
2. Repeat surgery
3. If that fails or isn’t tolerated can try Tamoxifen

Question 15

How do we stage ovarian cancer?

Answer 15

Pathology after surgery:

1. Ovarian with capsule intact
2. Spread into pelvis
3. Peritoneal implants outside pelvis or nodal involvement
4. Distant mets

Question 16

Who would we screen for ovarian cancer?

Answer 16

Only high risk women i.e.:

• Carrying BRCA genes or HNPCC
• 2+ relatives with OC

Question 17

How do we screen for ovarian cancer?

Answer 17

Pelvic exam, US and CA 125

Question 18

What can we do for very high risk women?

Answer 18

Prophylactic Oophorectomy once they’re done having family, usually around 40

Question 19

Why is screening for ovarian cancer not recommended?

Answer 19

Limited sensitivity/specifity.