Ovarian Cancer Flashcards
It is the ….commonest gynaecological cancer in the UK
Second
What is the percentage survival at 10 years?
35%
What percentage of cases are preventable?
11%
Is the incidence rising?
Yes
What is the lifetime risk?
1:50
What is the peak incidence age?
70-74
Occurs predominantly in 5,6,7th decades
Why does it generally carry poor prognosis?
Late diagnosis
Spread is usually to peritoneum - often advanced at this stage
Vague symptoms
Is there pre malignant staging?
No
What is the most common origin for ovarian cancers?
Surface epithelial origin (90%) - serous, mucinous, endometriod, clear cell, Brenner
Other than originating from epithelial cell line, what other cells can it originate from?
Germ cells
Stromal / sex cord
Miscellaneous and metastatic
What risk factors are there?
Obesity Nulliparity Early menarche and late menopause (many ovulations) Unopposed oestrogen FH BRCA 1/2 mutations HNPCC Endometriosis Talcum powder, asbestos
What factors reduce the risk?
COCP Parity Breast feeding Hysterectomy Oophorectomy Sterilisation Statins
What is the risk if there is a FH of BRCA1 mutation?
50%
If BRCA2 : 27%
What is the risk if history of HNPCC?
12%
What is the commonest type of epithelial malignancy?
Serous - can be benign or malignant
Also:
Mucinous = common, benign or malignant
Endometriod = uncommon, usually malignant
Clear cell = uncommon, usually highly malignant
What is the commonest type of germ cell malignancy?
Teratoma (but usually benign)
Also:
Dysgerminoma = rare
Yolk sac = rare, malignant
Choriocarcinoma = rare, highly malignant
What do dysgerminomas secrete?
HCG
What does yolk sac cancers secrete?
AFP
What stromal/ sex cord cancers are there?
Granulosa cell = rare, low grade, secretes oestrogen, which can cause PMB
Theca cell = rare, usually benign, secretes oestrogen
Sertoli-Leydig = rare, may secrete androgens
How does it present?
Non specific symptoms Abdominal swelling 50-65% Pain - abdominal and pelvic 50-60% Anorexia 20% Nausea and vomiting 20% Weight loss 15% Vaginal bleeding especially PMB 15% Bowel symptoms e.g diarrhoea, change in bowel habit 5% Urinary symptoms e.g frequency or urgency
What can the symptoms be misinterpreted as?
IBS
Diverticular disease
What percentage present once disease has reached FIGO stage 3?
75%
What May examination reveal?
Fixed abdominal/ pelvic mass Ascites Omental mass Pleural effusion Supraclavicular LN enlargement
What investigations should be done?
USS
FBC, U&E, LFTs
CA125 - done initially for baseline
CXR for staging - look for pleural effusion, lung mets
CTAP - assess peritoneal, omental, retroperitoneal disease
MRI may be useful to help distinguish from benign and malignant disease
Ascites or pleural effusion can be sampled and sent for cytology
Surgical exploration and histology (diagnosis is difficult and usually involves diagnostic laparotomy)
What other conditions can also raise CA125?
Endometriosis
Menstruation
Benign ovarian cysts
Should CA125 be used for screening in asymptomatic women?
No
What is stage I disease?
Limited to ovaries = 90% 5 year survival
What is stage II disease?
Limited to pelvis = 60% 5 year survival
What is stage III?
Limited to abdomen, including regional lymph node mets = 30% 5 year survival
What is stage IV?
Distant mets outside abdominal cavity = 5% 5 year survival
What does treatment depend on?
Tumour stage
How are epithelial ovarian cancers treated ?
Surgery and chemotherapy
Staging laparotomy, TAH+BSO+debulking
Platinum based chemotherapy and taxane
In women of reproductive age, where tumour confined to one ovary, what can be done?
Ophorectomy only may be considered
Non epithelial cancers often occur in…
Younger women
They can be very chemotherapy sensitive
