Ovarian cancer

Question 1

Give 5 risk factors for ovarian cancer

Answer 1

Lots of ovulation: - Early menarche - Late menopause - Nulliparity - Endometriosis Lifestyle: - Obesity - Smoking - Lack of exercise Family history of ovarian cancer or breast cancer: - HNPCC (bowel + ovarian + endometrial) - BRCA 1 and 2 (breast and ovarian)

Question 2

Give 3 protective factors for ovarian cancer

Answer 2

COCP use Previous pregnancy Early menopause Tubal ligation Breast feeding

Question 3

What are the 2 indications for urgent referral for woman with suspected ovarian cancer?

Answer 3

Pelvis mass (not attributable to fibroids) Ascites

Question 4

When would blood tests be indicated for a woman (especially if over 50) with suspected ovarian cancer in primary care?

Answer 4

Persistent abdominal distension (often referred to this as ‘bloating’). Feeling full (early satiety) and/or loss of appetite. Pelvic or abdominal pain. Increased urinary urgency and/or frequency.

Question 5

What is the marker for ovarian cancer?

Answer 5

CA-125

Question 6

What are 4 types of ovarian cancer? Which is most common?

Answer 6

Epithelial (most common - 80%) Sex chord Germ cell Secondary (Krukenberg tumours)

Question 7

What are examples of epithelial, germ cell and sex chord tumours respectively?

Answer 7

Question 8

What is the cutoff for CA-125 tumour marker which warrants USS?

Answer 8

>35IU/ml

Question 9

Lady has elevated CA-125 > 35IU/ml and abnormal USS. What should the next step be?

A) Admit to A + E

B) Urgent 2 WW referral

C) Routine appt with gynae oncology

D) Counselling over cancer possibility

E) 6 week wait referral

Answer 9

B) 2 WW referral

Question 10

What is the staging for ovarian cancer?

Answer 10

Stage 1 - tumour confined to ovary

Stage 2 - Tumour outside ovary but within pelvis

Stage 3 - Tumour outside pelvis but within abdomen

Stage 4 - Distant metastasis

Question 11

A 72-year-old woman with ovarian cancer is seen in the gynaecological oncology clinic. There, the consultant talks through her pre-surgical prognosis, based on her risk malignancy index (RMI). What are the three components of the RMI?

Answer 11

CA-125 levels

Menopause status

USS findings

Question 12

38 year old woman with suspected ovarian cancer. What 3 tests should you run?

Answer 12

CA-125

AFP

b-hCG

Woman of that age may not have epithelial ovarian cancer, and may have yolk sac ovarian cancer

Question 13

What is the gold standard for diagnosing ovarian cancer?

Answer 13

Tissue diagnosis via laparotomy

Alternatively: percutaneous image-guided biopsy or laparascopic biopsy

Question 14

You meet this lady in the gynae onco clinic, she has elevated CA-125 and USS suggests ovarian cancer, what imaging would you do next to stage the cancer?

Answer 14

CT abdomen/ pelvis +/- chest

Question 15

Standard treatment for someone with ovarian cancer?

Answer 15

Staging laparotomy:

• Midline laparotomy
• Hysterectomy
• Bilateral salpingo-oophrectomy
• Omenectomy
• Lymph node sampling (para-aortic/pelvic nodes)
• Peritoneal washing (saline solution injected into peritoneal cavity and then removed for cytology)

Question 16

How to manage confirmed Stage 1 ovarian cancer?

Answer 16

Perform retroperitoneal lymph node assessment as part of optimal surgical staging

Question 17

What sort of chemo used for the different stages of ovarian cancer?

Answer 17

Stage 1c/grade 3 - 6 cycles of carboplatin

Stages 2 - 4: paclitaxel

Do not offer chemotherapy to women who have had optimal surgical staging and have low-risk stage I disease (grade 1 or 2, stage Ia or Ib).

Question 18

What is the USS appearance of ovarian cancer?

Answer 18

Septations

Echogenic mass (Solid area)

Bilateral

Ascites

Multiloculated appearance

Increased blood flow