Ovarian Cancer Flashcards
Ovarian cancer Ix
TVUSS Tumour markers (CA125) RMI CT+/-MRI Aspiration of ascites USS/CT needle biopsy
What does TVUSS tell you about ovarian cancers?
Size Consistency Solid elements? Bilaterality Ascites? Extraovarian Dx (peritoneal/omental deposits)
Raised CA125?
(80% of epithelial) Ovarian cancers
Pregnancy
Endometriosis
Alcoholic liver dx
RMI
Risk of malignant index Calculated from: - menopausal status - pelvic USS - CA125 >250 high, <25 low
CT/MRI in Ovarian cancer
Indicated in any suspicious pelvic pathology
CT good for staging
MRI determines operability
Surgical Mx of Ovarian Cancer
Stage Dx and remove all visible tumour TAH+BSO + omentectomy Ascites/peritoneal washings sampled ?Further debulking (bowel, peritoneal stripping) LN rescetion important
Most important prognostic factor in ovarian cancer
No residual disease following laparotomy
If unsuitable for ovarian cancer surgery
Chemotherapy w/second look laparotomy to see extent of residual disease
Summary of Mx of ovarian cancer
Surgery w/Pt based chemo
Aim: <1cm residual macroscopic tissue
Ovarian tumour deposits amenable to resection?
Bowel, spleen, peritoneum
Ovarian tumour deposits not amenable to resection?
porta hepatis, bowel mesentary
Supraradical ovarian cancer surgery
BSO+TAH+omentectomy and lympheadenectomy + removal of all visible disease
indicated in prev. fit women w/disseminated dx if complete cytoreduction possible
a/w perioperative mort/morb.
Alternative to supraradical surgery
3 cycles of neoadjuvant chemo followed by debulking is not inferioir and a/w less morbidity
Chemotherapy in ovarian cancer
Can be primary treatment, adjunct or for relapse
1st line: Pt agent w/paclitaxel
OP 3wks apart 6 cycles
Platinum compounds in ovarian cancer
Most effective Cross linkage of DNA strands Carboplatin main compound (less nephrotox. and nausea and cisplatin) Dose of carboplatin calculated using GFR
Paclitaxel
Ovarian cancer
Microtubular damage prevents cell replicaton
Preemptive steroids for SE (peripheral neuropathy, neutropenia, myalgia)
Total loss of body hair
Bevacizumab
Ovarian cancer
mAb anti-VEGF
expensive
Mx of recurrent disease
Follow up after ovarian chemo
CT to assess response
CA125
Prognosis in ovarian cancer
5 year survival: 46%, stage 1 90%, stage 3 30%
PACES Counselling of ovarian cancer
RF: age, FHx, obesity, HRT, endometriosis, smoking, DM
Protective factors: COCP, pregnancy, breastfeeding, hysterectomy
Dx: cancer of the ovaries
Ix: scans, bloods
Mx: chemo +/- surg
Sex cord stromal tumour
granulosa and thecal cells
Sex cord stromal tumour Mx
Based on age, wish to preserve fertility
- Young: unilateral salpingoophectomy, endometrial sampking sufficient
- Old: full surgical staging
No effective chemotherapy
Which sex cord stromal tumour recurrs?
Granulosa cells so require long term FU
Germ cell tumour
Seminoma
Dysgerminoma
Embryonic
