Ovarian Cancer Flashcards
From where does ovarian cancer arise?
Most actually arise from the fallopian tube
Some arise from benign ovarian cysts, these are generally lower grade cancers
Some people are at a higher genetic risk of developing ovarian cancer, who dis?
- People in HNPCC families
- Or carriers of BRCA genes
What are the BRCA genes?
Tumour suppressor genes
Certain mutations are passed on by Autosomal Dominant inheritence
How much risk are BRCA 1 & 2 carriers at?
15-45% lifetime risk of Ovarian Cancer
Also develop Ovarian and breast very young
What other things are risk factors for Ovarian CanceR?
Being older Incessant ovulation (i.e. not using OCP or being pregnant)
How does Ovarian Cancer present?
Notoriously vague symptoms:
- abdo distension & bloating
- abdo / pelvic pain
- urinary symptoms
- poor appetite / early satiety
May feel a pelvic mass
How do we test if we suspect ovarian cancer?
CA125 test
USS - pelvic & abdomen
+/- CT
What is CA 125?
A serum biomarker raised in peritoneal damage e.g. ascites, endometriosis, PID, breast cancer, liver disease or ovarian cancer
How do we calculate risk for Ovarian cancer?
This is useful as we cant easily examine for it as we would for cervical cancer for example
Risk of malignancy index (RMI): US x M x CA125
US - US features of malignancy
M - Menopausal status
What US featuers apply to the RMI?
1 feature = 1point
2+ = 3 points
- Multi-locular
- Solid areas
- Bilateral
- Ascites
- Intra-abdominal
How do we score a woman’s menopausal status on RMI?
Pre-menopause = 1 Post-menopause = 3
Whats an abnormal CA125?
> 35
How is Ovarian cancer treated?
Laparotomy with adjuvant/neo-adjuvant chemo
What is ovarian cancer recurs?
2nd line chemo
Repeat surgery
If that fails or isn’t tolerated can try Tamoxifen
How do we stage ovarian cancer/
Pathology after surgery: 1 = Ovarian with capsule intact 2 = spread into pelvis 3 = Peritoneal implants outside pelvis or nodal involvement 4 = Distant mets
