Ovarian Cancer Case Study Flashcards
What are the risk factors for ovarian cancer?
- Peak age 60-64 YO
- Hereditary in 10% of cases, especially if hx of breast cancer (BRCA1 gene) or family member with cancer
- Shared lifestyle factors can also cause a hereditary pattern
- Hereditary ovarian cancer syndrome
- Caucasian and Jewish heritage (more likely to carry fault tumor suppressor genes like the BRCA)
- Low or null parity
- Early menarche
- Late menopause
- History of PID
- History of endometriosis
- Low serum gonadotropin
- Use of talcum powder (possible asbestos exposure)
- Use of fertility enhancing drugs or hormone replacement therapy increasing risk
- Lynch syndrome
- Misc factors like smoking, asbestos exposure, obesity, eating certain foods, etc.
What is ovarian cancer?
- The most lethal gynecologic cancer
- Fifth most common of women in U.S.
- Lifetime risk is 1 in 70
- Overall 5-year survival is 53%
- Difficult to detect early stage and fairly resistant to chemotherapy treatments
- Median age of diagnosis is 63, with incidence rates steadily increasing until age 80, where it declines
- Tumors can be either benign, of low malignant potential or invasive cancers
What are the types of major pathological ovarian cancers?
1) Epithelial (90% of cancers, rise from surface of ovary)
2) Germ cell (precursors of ova)
3) Sex-cord stromal (secrete hormones that connect ovary together)
Describe the pathophysiology of ovarian cancer:
- Primary method of metastasis is by exfoliation of cells implanted along surfaces of peritoneal cavity via lymph or blood dissemination (commonly opposite ovary, uterus, fallopian tubes, omentum, bladder and rectum)
- Theories are that it arises d/t incessant ovulation (# of cycles and repetitive trauma/repair caused by ovulation) and/or excess gonadotropin secretion (high estrogen concentration = increased proliferation)
What decreases the risk of ovarian cancer?
- Oral contraceptives decrease by 30-60%
- Lactating and breastfeeding during pregnancy
- Having many children
- Tubal ligation and oophorectomy
What are significant diagnostics and testing in ovarian cancer?
- Regular rectovaginal pelvic examinations
- For high risk women, having CA-125 blood tests and trans-vaginal UC performed q6-12 months between ages 25-35
- CBC/electrolytes
- CT/MRI/CXR etc. for mets
- Liver tests (for mets)
- Blood hormone levels (elevated estrogen and testosterone)
- Exploratory lap
Describe stage IA, B and C Ovarian Ca:
1: Limited to ovaries
1A: limited to one ovary, no ascites/tumor
1B: growth limited to both ovaries, no ascites/tumor
1C: tumor stage A or B but with ruptured capsule and ascites
Describe stage IIA, B and C Ovarian Ca:
2: growth of one or both ovaries with pelvic extension
2A: extension or mets to uterus/tubes
2B: extension to other pelvic tissues
2C: either 2A or B with tumor, ruptured capsule, ascites or positive peritoneal washings
Describe stage IIIA, B and C Ovarian Ca:
3: tumor one or both ovaries with peritoneal implants outside pelvic, liver mets, malig extension to bowel
3A: tumor with neg nodes but seeding in abd peritoneal surfaces
3C: abd implants 2cm+ in diameter or positive nodes
Describe stage IV Ovarian Ca:
Growth of one or both ovaries with distant mets; pleural effusion with positive cytologic testing; parenchymal liver mets late stage
Describe early manifestations of Ovarian Ca:
- Vague and diffuse
- Dyspepsia
- Abdominal discomfort
- Back pain
- Loss of appetite
- Changes in bowel habits
- Bloating
- Eructation
- Increase in pelvic pressure
- Vaginal bleeding
- GU changes
Describe late manifestations of Ovarian Ca:
- Palpable abd. mass
- Ascites ** (dyspnea, sense of heaviness, fatigue, edema in extremities) (1/3 will have ascites at diagnosis!)
- Increased abdominal girth
- Pleural effusion
- SOB
- Weight loss
- N/V
- Intestinal obstruction
- Vaginal bleeding
How can we increase comfort in patients with ascites?
- Position onto left side to decrease weight on organs
- eat small, frequent, high-protein meals
- Parenteral nutrition may be needed as a temporary or permanent (e.g. palliative) solution
- Measure abd. girth and weights
- Advocate fr drainage if impaired quality of life and causing significant distress
Why do these patients develop ascites?
- Blockage of lymph channel by tumor, producing excessive retention of fluid
- Removal of lymph nodes during surgery
- Potential for liver mets
What other causes might a CA-125 be elevated by?
- Pregnancy
- PID
- Endometriosis
- Inflammatory colon cancer
