Ovarian Cancer Flashcards
How does ovarian cancer present?
pressure symptoms swelling mass change of bowel habit weight loss/anorexia leg oedema/DVT often early transperitoneal spread - ascites, omental disease, peritoneal spread
What investigations are done for ovarian cancer?
CA 125 - raised in 80% of ovarian cancers
RMI - score based on ultrasound features + CA 125
USS - transvaginal/abdo
cytology of ascites/pleural fluid
CT guided biopsy for pathology
What RMI score idicates that 75% of patients will have ovarian cancer?
> 200
What is the treatment for germ cell tumours?
unilateral salpingoophrectomy +/- chemo
What is the treatment for stage 1a ovarian cancer?
surgery
What is the treatment for stage >1b ovarian cancer?
surgery and chemotherapy
What is the aim of surgery?
to debulk the tumour
What is Knuchenburg tumour?
comes from stomach cancer
What is the histology of Knuchenburg tumour?
signet ring
What other cancers can metastesise to the ovaries?
breast
pancreas
stomach
GI
What are the risk factors for ovarian cancer?
> 50yrs multiparty/low parity delayed pregnancy BRACA 1 - 40% BRACA 2 - 18% FH of breast or ovarian cancer
What two ways does ovarian cancer spread?
transcoleomic -> abdo cavity
haematogenous spread -> liver, lung, brain (rare)
How is ovarian cancer screened for in high risk groups?
prophylactic salpingo-oophrectomy
What are the different types of ovarian cancers?
epithelial tumours: serous mucinous endometroid clear cell brenner
germ cell tumours
sex cord/stromal tumours
What is the precursor lesion for high grade serous tumours?
serous tubual intraepithelial carcinoma
What is the precursor lesion for low grade serous tumours?
serous borderline tumour
What are the characteristics of endometroid and clear cell carcinoma?
associated with endometriosis of the ovary and Lynch syndrome
most are low grade and early stage
How are endometroid and clear cell carcinomas diagnosed?
ascitic fluid
What is a Brenner tumour?
tumour of transitional epithelium that is usually benign
What % of ovarian tumours are epithelial and what % are germ cell?
60-70% epithelial
15-20% germ cell
What type of germ cell tumours occur in the ovary?
teratoma
yolk sac tumour
chroiocarcinoma
dysgerminoma
What is a dermoid cyst?
most common germ cell tumour (95%)
usually benign but can rarely become malignant
What are the types of sex cord/stromal tumours?
fibroma/thecoma
granulosa cell tumour
sertoli-leydig cell tumour
Describe a fibroma/thecoma?
benign but may produce oestrogen + cause uterine bleeding
Describe granulosa cell tumour?
all potentially malignant
may be associated with increased oestrogen
Describe sertoli-leydig cell tumour?
rare
may produce androgens
