Ovarian Cancer Flashcards
Is ovarian cancer common
- 600 cases/year in Scotland
- 400 deaths - 23.8 per 100,000
- Fairly uncommon
Does ovarian cancer have a good prognosis
- 5-year survival 30% at all stages
- Most present with advanced disease
What are the common ages for ovarian cancer
- Rare <30
- 50s/60s most common
What are risk factors for ovarian cancer
- ‘Incessant ovulation’
- High-risk families - 50-10% of cases, start younger, better prognosis
Who are the high risk families for ovarian cancer
- HNPCC/Lynch type II familial cancer syndrome
- BRAC1
- BRAC2
What is protective against ovarian cancer
- OCP
Symptoms of ovarian cancer
- Vague
- Indigestion/early satiety/poor appetite
- Altered bowel habit/pain
- Bloating/discomfort/weight gain
- Pelvic mass
- Asymptomatic
- Pressure symptoms
- Can be quite big without knowing - only aware when moved into the abdomen
How is ovarian cancer diagnosed
- Surgical/pathological - post-operative diagnosis
- US scan abdomen and pelvis
- CT scan
- CA125
- Surgery
What is CA125 (used in ovarian cancer) and what is the normal value
- Glycol-protein antigen
- Normal - world 35
Why would CA125 be raised
- Malignancy
- Ovary
- Colon/pancreas
- Breast
- Benign condition
- Menstruation/endometriosis/PID
- Liver disease/recent surgery/effusions
- Any inflammation etc. in the abdomen
Is CA125 used for screening in ovarian cancer
- No as not specific enough
- 80% with ovarian cancer have raised CA125
- 50% with stage 1
- Used to detect and monitor epithelial ovarian tumours
What is the RMI used in ovarian cancer
- RMI = U x M x CA125
- Ultrasound features
- Menopausal status
- CA125 value
What are the ultrasound features used in RMI
- 1 for 1, 3 for >2
- Multi-follicular
- Solid areas
- Bilateral
- Ascites
- Intra-abdominal
How is ovarian cancer staged
- Stage 1 - limited to ovaries with capsule intact/- cytology
- 1 or both ovaries
- Stage 2 - 1 or both ovaries with pelvic extension
- Stage 2 if on surface of liver, inside or spleen then upstaged
- Stage 3 - 1 or both ovaries with peritoneal implants outside pelvis or + nodes
- Stage 4 - distant mets
What is the treatment for ovarian cancer
- Surgery
- Chemo
- Adjuvant
- Neoadjuvant
Why are laparotomies used in ovarian cancer
- Obtain tissue for diagnosis
- Stage disease
- Disease clearance
- Debulk disease
What chemo is used in ovarian cancer
- Platinum and taxan (Taxol)
- Within 8 weeks of surgery
- Complete/partial response
- Cure unlikely
- Average response 2 years
How is recurrence of ovarian cancer treated
- Chemo
- Palliative
- Symptomatic
- Platinum if > 6 months
- Surgery
- Tamoxifen
What is the 5-year survival of ovarian cancer
- Stage 1 - 85%
- Stage 2 - 47%
- Stage 3 - 15%
- Stage 4 - 10%
What do nodules suggest in ovarian cancer
- Multiple nodules suggest malignancy (benign cysts are unimodular)
- Multiple nodules often within the omentum - stage 3
What is a borderline ovarian cyst
- Tend to be in younger women
- Multinodular with papillary areas
- Unsure how they are going to act
- Can get cancer further down the line
Is ovarian cancer screened for
- Population screening not proven
- Not recommended
- High risk women
- Cancer gene mutations carriers
- 2 or more relatives
How is ovarian cancer screened for (in those that qualify)
- Pelvic examination
- US scanning of ovaries
- CA125
- Limited sensitivity and specificity
- FIGO stages detected
What can women who are a high risk for ovarian cancer have
- Prophylactic oophorectomy
- Removal of the tubes and ovaries around 4-45 years
- Residual risk of primary peritoneal cancer
Where do most cases of ovarian cancer originate
- Fallopian tube
- High risk families remove tubes and leave ovaries until mid 40s
- Some from pre-existing ovarian cysts (often low grade)
What role does the BRCA gene play in ovarian cancer
- Autosomal dominant inheritance
- 15-35% lifetime risk of ovarian cancer
- BRCA genes are tumour suppressor genes involved in DNA repair and cell cycle control
- Develop ovarian cancer (and breast cancer) at a younger age
