Ovarian Cancer

Question 1

How does ovarian cancer present?

Answer 1

pressure symptoms
swelling
mass
change of bowel habit
weight loss/anorexia
leg oedema/DVT
often early transperitoneal spread - ascites, omental disease, peritoneal spread

Question 2

What investigations are done for ovarian cancer?

Answer 2

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

Question 3

What RMI score idicates that 75% of patients will have ovarian cancer?

Answer 3

> 200

Question 4

What is the treatment for germ cell tumours?

Answer 4

unilateral salpingoophrectomy +/- chemo

Question 5

What is the treatment for stage 1a ovarian cancer?

Answer 5

surgery

Question 6

What is the treatment for stage >1b ovarian cancer?

Answer 6

surgery and chemotherapy

Question 7

What is the aim of surgery?

Answer 7

to debulk the tumour

Question 8

What is Knuchenburg tumour?

Answer 8

comes from stomach cancer

Question 9

What is the histology of Knuchenburg tumour?

Answer 9

signet ring

Question 10

What other cancers can metastesise to the ovaries?

Answer 10

breast
pancreas
stomach
GI

Question 11

What are the risk factors for ovarian cancer?

Answer 11

> 50yrs
multiparty/low parity
delayed pregnancy
BRACA 1 - 40%
BRACA 2 - 18%
FH of breast or ovarian cancer

Question 12

What two ways does ovarian cancer spread?

Answer 12

transcoleomic -> abdo cavity

haematogenous spread -> liver, lung, brain (rare)

Question 13

How is ovarian cancer screened for in high risk groups?

Answer 13

prophylactic salpingo-oophrectomy

Question 14

What are the different types of ovarian cancers?

Answer 14

epithelial tumours:
serous
mucinous
endometroid
clear cell
brenner 

germ cell tumours
sex cord/stromal tumours

Question 15

What is the precursor lesion for high grade serous tumours?

Answer 15

serous tubual intraepithelial carcinoma

Question 16

What is the precursor lesion for low grade serous tumours?

Answer 16

serous borderline tumour

Question 17

What are the characteristics of endometroid and clear cell carcinoma?

Answer 17

associated with endometriosis of the ovary and Lynch syndrome
most are low grade and early stage

Question 18

How are endometroid and clear cell carcinomas diagnosed?

Answer 18

ascitic fluid

Question 19

What is a Brenner tumour?

Answer 19

tumour of transitional epithelium that is usually benign

Question 20

What % of ovarian tumours are epithelial and what % are germ cell?

Answer 20

60-70% epithelial

15-20% germ cell

Question 21

What type of germ cell tumours occur in the ovary?

Answer 21

teratoma
yolk sac tumour
chroiocarcinoma
dysgerminoma

Question 22

What is a dermoid cyst?

Answer 22

most common germ cell tumour (95%)

usually benign but can rarely become malignant

Question 23

What are the types of sex cord/stromal tumours?

Answer 23

fibroma/thecoma
granulosa cell tumour
sertoli-leydig cell tumour

Question 24

Describe a fibroma/thecoma?

Answer 24

benign but may produce oestrogen + cause uterine bleeding

Question 25

Describe granulosa cell tumour?

Answer 25

all potentially malignant

may be associated with increased oestrogen

Question 26

Describe sertoli-leydig cell tumour?

Answer 26

rare

may produce androgens