Ovarian Cancer

Question 1

Survival Rate

Answer 1

50% at 10 years

Question 2

Incidence and survival

Answer 2

• Highest incidence age 75-79 years
• 53% in >65 years old

Question 3

Presentation

Answer 3

• ‘Silent killer’ - >60% advanced disease at initial presentation
• Abdominal pain in year preceding diagnosis common
• Altered bowel habit
• Feeling full quickly
• Difficuty eating
• Urinary/pelvic symptoms
• Bowel obstruction
• SOB
• Abdominal distension (pelvic mass, ascites)
• Upper abdominal mass (omental disease)
• Pleural effusion
• Nodules on PV examination
• Rarely - paraneoplastic syndromes

Question 4

Types of ovarian cancer

Answer 4

• Epithelial (90%) - derived from serosal surface
• Germ cell - arise from oocytes
• Ovarian stromal - non germ cell/non epithelial components
• Metastasis - aka Krukenburg

Question 5

Types of epithelial ovarian cancer

Answer 5

• High grade serous - resembles fallopian tube, P53 mutations
• Endomentroid, clear cell, mucinous, low grade serous - arise from ovarian surgace epithelium and Mullerian inclusion cysts

Question 6

Spread of ovarian cancer

Answer 6

• Direct extension (transcoelemic)
• Exfoliation into the peritoneal cavity
• Lymphatic invasion

Question 7

Risk factors

Answer 7

• Smoking
• Low parity
• Oral contraceptives (50% reduction with 5 years of use)
• Infertility
• Infertility but independent of drugs
• Tubal ligation
• Early menarche
• Late menopause

Question 8

Familial mutations

Answer 8

• BRCA1 - Chromosome 17q
• BRCA2 - Chromosome 13q
• Lynch syndrome/HNPCC

NB - early onset Br Ca, male Br Ca, bilateral Br Ca and Ashkenazi Jewish ancestry are features suggestive of these mutations

Question 9

Risk reducing surgery

Answer 9

• Prophylactic bilateral saplingo-oopherectomy (BSO)

Question 11

Investigations

Answer 11

• USS
• CA125
• Calculate RMI
• CT (to determine treatment + response)

Question 12

Risk of Malignancy Index (RMI)

Answer 12

• U x M x CA125
• U = USS, M = menopausal status
• RMI >200 CT and refer to MDT

Question 13

Diagnosis

Answer 13

• Cytology (pleural/ascitic fluid)
• Histology

Question 14

Staging system

Answer 14

FIGO

Question 15

Management

Answer 15

• Surgery
  
  • TAH, BSO, washings, omentectomy +/- appendicetomy/resection of peritoneal deposits
  • Ultra radical includes splenectomy, bowel resection, peritoneal stripping
• Chemotherapy (neo-adjuvant or adjuvant)
  
  • Platinum agent first line
• Fertility conserving surgery