Ovarian Cancer Flashcards
Mean age of onset
63
Presentation:
Why is it always discovered late?
How does it present in postmenopausal women?
What new GI disease should you be suspicious of in women >50 yrs?
Typical cancer symptoms
Non-existent or vague symptoms
Abdominal pain and distention (‘bloating’)
IBS
Early satiety
Weight loss
Nausea
Signs on abdomen?
Palpable pelvis mass
Tender adnexa
Local mass effects:
Bladder - 1
Ureters - 3
Bowel - 2
Urinary frequency
Hydronephrosis
Recurrent UTI
Haematuria
Constipation
Obstruction
Mets or complications:
Why might you get back pain?
Why might you get ascites?
Why might you get pleural effusion?
Where may there be lymphadenopathy?
Spinal met
There are a number of reasons why ascites can develop. For example, when cancer cells spread to the lining of the abdomen (peritoneum), they can irritate it and cause fluid to build up. Also, cancer can block part of the lymphatic system so fluid can’t drain out of the abdomen as usual.
Pleural effusion can be caused by cancer cells spreading to the pleura. It can also develop if cancer cells block or change the flow of lymph fluid in the pleural cavity.
Supraclavicular lymphadenopathy
Risk factors:
Risks related to the menstrual cycle -
What is protective against ovarian cancer?
What type of contraception is protective?
Early menarche
Late menopause
HRT
Having many ovulations
Obesity
Multiparity - multiple pregnancies
Breastfeeding
COCP
Risk factors:
Genetic:
- How many times does FH increase your risk?
- Genes linked to ovarian cancer?
What other cancer can also increase their risk even in the FH?
FH - 3-4 times
BRCA1 and BRCA2
HNPCC
Breast cancer
1st degree relative of a woman with O or B cancer <50 yrs old who herself has:
(a) a 1st degree relative with O cancer
OR
(b) 2nd degree relative with O or B cancer via an unaffected male
DDx
Benign ovarian tumours
Primary peritoneal cancer - histologically identical to ovarian cancer
Fallopian tube cancer - watery discharge, bleeding and pain
IBS
Endometriosis
Investigations:
Imaging used first?
What tumour marker can be used to monitor Rx and possible follow up?
What score is used for ovarian cancer risk?
TVUS
CA-125 - being high is suggestive but not diagnostic
Risk of malignancy score - (RMI)
Further Investigations:
What imaging can be used pre-op and monitoring?
Bloods needed pre-op and pre-chemo?
What LFT might be raised suggesting liver mets?
Why is a CXR done?
CT and MRI
FBC
U+E
LFT
Coag screen
Raised alkaline phosphate
Pleural effusion
Lung mets
Diagnosis:
What is a laparotomy?
What can be done to confirm the diagnosis of OC even though it is indicated by other investigations?
A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy.
Histology
FIGO staging:
Stage 1, 2, 3 and 4
1 - Ovaries only
2 - Pelvis
3 - Early mets - superficial liver, microscopic peritoneal mets
4 - Distant mets
Management:
What is done first - surgery of chemo?
Surgery:
An HSO and omentectomy and appendectomy is done. What is it?
Surgery then adjuvant chemotherapy
Bilateral hystero-salpingo-oophorectomy - removal of uterus, tubes and ovaries
Omenctectomy - Remove the omentum, which is a thin fold of abdominal tissue that encases the stomach, large intestine and other abdominal organs. This fatty lining contains lymph nodes, lymph vessels, nerves and blood vessels.
Appendectomy - removal of the appendix
Management:
What stage doesn’t need chemo?
Radiotherapy is rarely used. When might it be used?
Stage 1
For residual tumour
Prevention:
Indications for prevention
Procedures that can be done?
High risk or BRCA 1/2 high
Oophorectomy
Tubal ligation
Hysterectomy
