Ovarian Cancer

Question 1

Is ovarian cancer common

Answer 1

• 600 cases/year in Scotland
  
  • 400 deaths - 23.8 per 100,000
• Fairly uncommon

Question 2

Does ovarian cancer have a good prognosis

Answer 2

• 5-year survival 30% at all stages
• Most present with advanced disease

Question 3

What are the common ages for ovarian cancer

Answer 3

• Rare <30
• 50s/60s most common

Question 4

What are risk factors for ovarian cancer

Answer 4

• ‘Incessant ovulation’
• High-risk families - 50-10% of cases, start younger, better prognosis

Question 5

Who are the high risk families for ovarian cancer

Answer 5

• HNPCC/Lynch type II familial cancer syndrome
• BRAC1
• BRAC2

Question 6

What is protective against ovarian cancer

Answer 6

• OCP

Question 7

Symptoms of ovarian cancer

Answer 7

• 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

Question 8

How is ovarian cancer diagnosed

Answer 8

• Surgical/pathological - post-operative diagnosis
• US scan abdomen and pelvis
• CT scan
• CA125
• Surgery

Question 9

What is CA125 (used in ovarian cancer) and what is the normal value

Answer 9

• Glycol-protein antigen
• Normal - world 35

Question 10

Why would CA125 be raised

Answer 10

• Malignancy
  
  • Ovary
  • Colon/pancreas
  • Breast
• Benign condition
  
  • Menstruation/endometriosis/PID
  • Liver disease/recent surgery/effusions
• Any inflammation etc. in the abdomen

Question 11

Is CA125 used for screening in ovarian cancer

Answer 11

• No as not specific enough
  
  • 80% with ovarian cancer have raised CA125
  • 50% with stage 1
• Used to detect and monitor epithelial ovarian tumours

Question 12

What is the RMI used in ovarian cancer

Answer 12

• RMI = U x M x CA125
  
  • Ultrasound features
  • Menopausal status
  • CA125 value

Question 13

What are the ultrasound features used in RMI

Answer 13

• 1 for 1, 3 for >2
  
  • Multi-follicular
  • Solid areas
  • Bilateral
  • Ascites
  • Intra-abdominal

Question 14

How is ovarian cancer staged

Answer 14

• 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

Question 15

What is the treatment for ovarian cancer

Answer 15

• Surgery
• Chemo
  
  • Adjuvant
  • Neoadjuvant

Question 16

Why are laparotomies used in ovarian cancer

Answer 16

• Obtain tissue for diagnosis
• Stage disease
• Disease clearance
• Debulk disease

Question 17

What chemo is used in ovarian cancer

Answer 17

• Platinum and taxan (Taxol)
• Within 8 weeks of surgery
• Complete/partial response
• Cure unlikely
• Average response 2 years

Question 18

How is recurrence of ovarian cancer treated

Answer 18

• Chemo
• Palliative
  
  • Symptomatic
  • Platinum if > 6 months
  • Surgery
  • Tamoxifen

Question 19

What is the 5-year survival of ovarian cancer

Answer 19

• Stage 1 - 85%
• Stage 2 - 47%
• Stage 3 - 15%
• Stage 4 - 10%

Question 20

What do nodules suggest in ovarian cancer

Answer 20

• Multiple nodules suggest malignancy (benign cysts are unimodular)
• Multiple nodules often within the omentum - stage 3

Question 21

What is a borderline ovarian cyst

Answer 21

• Tend to be in younger women
• Multinodular with papillary areas
• Unsure how they are going to act
• Can get cancer further down the line

Question 22

Is ovarian cancer screened for

Answer 22

• Population screening not proven
• Not recommended
• High risk women
  
  • Cancer gene mutations carriers
  • 2 or more relatives

Question 23

How is ovarian cancer screened for (in those that qualify)

Answer 23

• Pelvic examination
• US scanning of ovaries
• CA125
• Limited sensitivity and specificity
• FIGO stages detected

Question 24

What can women who are a high risk for ovarian cancer have

Answer 24

• Prophylactic oophorectomy
  
  • Removal of the tubes and ovaries around 4-45 years
• Residual risk of primary peritoneal cancer

Question 25

Where do most cases of ovarian cancer originate

Answer 25

• Fallopian tube
  
  • High risk families remove tubes and leave ovaries until mid 40s
• Some from pre-existing ovarian cysts (often low grade)

Question 26

What role does the BRCA gene play in ovarian cancer

Answer 26

• 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