Ovarian cancer Flashcards
What medication can reduce the risk of ovarian cancer?
Oral contraceptive pill (OCP)
What age group is ovarian cancer rare in?
<30yrs
What genetics/high risk families can be high risk of developing ovarian cancer?
HNPCC/Lynch syndrome
BRAC1
BRAC2
What is the incessant ovulation theory in ovarian cancer?
Suggests that the risk of ovarian carcinoma increases as a result of the recurrent minor trauma to the ovarian surface epithelium that occurs during ovulation
What are the signs/symptoms of ovarian cancer?
Often vague Indigestion/early satiety/poor appetite Altered bowel habit/pain Bloating/discomfort/weight gain Pelvic mass (pressure symptoms or asymptomatic)
What are the diagnostic techniques for ovarian cancer?
Surgical/pathological
US abdomen/pelvis
CT
CA125
What is a tumour marker for ovarian cancer?
CA 125
What is CA 125
Glyco-protein antigen
What benign conditions can CA 125 be raised in?
Menstruation Endometriosis PID Liver disease Recent surgery Effusions
What cancers can CA 125 be raised in?
Ovarian
Colon/pancreas
Breast
What percentage of women with ovarian cancer have raised CA 125?
80%
What is the RMI score?
Risk malignancy index
What is the RMI for ovarian cancer?
RMI = U x M x CA 125
What is the U and M in the RMI for ovarian cancer?
U = ultrasound evaluation M = menopausal status
What are ultrasound features you would look for when doing an RMI for ovarian cancer?
Multi-lobular Solid areas Bilateral Ascites Intra-abdominal
What is the staging for ovarian cancer?
Stage 1-4
What is stage 1 ovarian cancer?
Limited to ovaries with capsule intact
What is stage 2 ovarian cancer?
One or both ovaries with pelvic extension
What is stage 3 ovarian cancer?
One or both ovaries with peritoneal implants outside pelvis or + nodes
What is stage 4 ovarian cancer?
Distant metastasis
What are the two main options for treatment for ovarian cancer?
Surgery
Chemotherapy
What are the surgery options for ovarian cancer?
Laparotomy
Total abdominal hysterectomy (TAH)
Bilateral salpingo-oophorectomy (BSO)
What happens during a laparotomy for ovarian cancer?
Obtain tissue diagnosis
Stage disease
Disease clearance
Debulk disease
What is the first line chemotherapy for ovarian cancer?
Platinum and taxane (Taxol)
When is chemotherapy given for ovarian cancer?
Within 8 weeks of surgery
Complete/partial response
Cure unlikely
Average response 2yrs
What is the management if there is recurrence of ovarian cancer?
Chemotherapy Palliation Platinum >6mo ?Surgery Tamoxifen
Why tamoxifen in ovarian cancer?
Keep any estrogens circulating in the woman’s body from stimulating cancer cell growth
Who is screened for ovarian cancer?
High risk women: cancer gene mutation carriers, 2+ relatives
What can be screened for ovarian cancer?
Pelvic examination
US ovaries
CA 125
What surgery can be recommended for women at high risk of ovarian cancer?
Prophylactic oophorectomy
At what stage does ovarian cancer usually present?
Stage 3/4 disease
What are the normal values of CA 125?
<46 U/mL
What is the main type of ovarian cancer?
Epithelial
What is the main type of epithelial ovarian cancer?
Serous
What are the risk factors for ovarian cancer?
Low parity/infertility Early menarche Late menopause HRT Obesity Smoking Previous IBD Breast/bowel cancer Endometriosis Genetic Developed world
What are protective factors for ovarian cancer?
OCP
Childbearing
Breast feeding
Hysterectomy
What is not present in ovarian cancer which you’d expect of a gynaecological cancer?
Vaginal discharge and blood
What are some DD for ovarian cancer?
Benign ovarian tumours/cysts Fibroids Pelvic malignancies Endometriosis IBS/IBD Constipation Coeliac Gastroenteritis Diverticulitis
Where does ovarian cancer typically spread to?
*Greater omentum Liver Lungs Bone Cerebrum Lymph nodes
