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Reproductive Health > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

1
Q

It is the ….commonest gynaecological cancer in the UK

A

Second

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2
Q

What is the percentage survival at 10 years?

A

35%

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3
Q

What percentage of cases are preventable?

A

11%

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4
Q

Is the incidence rising?

A

Yes

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5
Q

What is the lifetime risk?

A

1:50

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6
Q

What is the peak incidence age?

A

70-74

Occurs predominantly in 5,6,7th decades

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7
Q

Why does it generally carry poor prognosis?

A

Late diagnosis
Spread is usually to peritoneum - often advanced at this stage
Vague symptoms

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8
Q

Is there pre malignant staging?

A

No

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9
Q

What is the most common origin for ovarian cancers?

A

Surface epithelial origin (90%) - serous, mucinous, endometriod, clear cell, Brenner

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10
Q

Other than originating from epithelial cell line, what other cells can it originate from?

A

Germ cells
Stromal / sex cord
Miscellaneous and metastatic

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11
Q

What risk factors are there?

A 
Obesity 
Nulliparity 
Early menarche and late menopause (many ovulations) 
Unopposed oestrogen 
FH 
BRCA 1/2 mutations
HNPCC 
Endometriosis 
Talcum powder, asbestos
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12
Q

What factors reduce the risk?

A 
COCP
Parity 
Breast feeding
Hysterectomy 
Oophorectomy 
Sterilisation 
Statins
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13
Q

What is the risk if there is a FH of BRCA1 mutation?

A

50%

If BRCA2 : 27%

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14
Q

What is the risk if history of HNPCC?

A

12%

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15
Q

What is the commonest type of epithelial malignancy?

A

Serous - can be benign or malignant

Also:
Mucinous = common, benign or malignant
Endometriod = uncommon, usually malignant
Clear cell = uncommon, usually highly malignant

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16
Q

What is the commonest type of germ cell malignancy?

A

Teratoma (but usually benign)

Also:
Dysgerminoma = rare
Yolk sac = rare, malignant
Choriocarcinoma = rare, highly malignant

17
Q

What do dysgerminomas secrete?

A

HCG

18
Q

What does yolk sac cancers secrete?

A

AFP

19
Q

What stromal/ sex cord cancers are there?

A

Granulosa cell = rare, low grade, secretes oestrogen, which can cause PMB
Theca cell = rare, usually benign, secretes oestrogen
Sertoli-Leydig = rare, may secrete androgens

20
Q

How does it present?

A 
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
21
Q

What can the symptoms be misinterpreted as?

A

IBS

Diverticular disease

22
Q

What percentage present once disease has reached FIGO stage 3?

A

75%

23
Q

What May examination reveal?

A 
Fixed abdominal/ pelvic mass 
Ascites
Omental mass
Pleural effusion
Supraclavicular LN enlargement
24
Q

What investigations should be done?

A

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)

25
Q

What other conditions can also raise CA125?

A

Endometriosis
Menstruation
Benign ovarian cysts

26
Q

Should CA125 be used for screening in asymptomatic women?

A

No

27
Q

What is stage I disease?

A

Limited to ovaries = 90% 5 year survival

28
Q

What is stage II disease?

A

Limited to pelvis = 60% 5 year survival

29
Q

What is stage III?

A

Limited to abdomen, including regional lymph node mets = 30% 5 year survival

30
Q

What is stage IV?

A

Distant mets outside abdominal cavity = 5% 5 year survival

31
Q

What does treatment depend on?

A

Tumour stage

32
Q

How are epithelial ovarian cancers treated ?

A

Surgery and chemotherapy
Staging laparotomy, TAH+BSO+debulking
Platinum based chemotherapy and taxane

33
Q

In women of reproductive age, where tumour confined to one ovary, what can be done?

A

Ophorectomy only may be considered

34
Q

Non epithelial cancers often occur in…

A

Younger women

They can be very chemotherapy sensitive

Reproductive Health (70 decks)

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