Ovarian cancer, cysts and torsion Flashcards
General presentation of Ovarian Cancer
often presents late due to the non-specific symptoms, resulting in a worse prognosis. More than 70% of patients with ovarian cancer present after it has spread beyond the pelvis.
Risk factors of Ovarian cancer
Age - peak 60y
BRCA1 and BRCA2 genes
Obesity
Increased number of ovulations
Smoking
Use of Clomifene
Give 3 examples of increased number of ovulations
early menarche
late menopause
no pregnancies
Protective factors for ovarian cancer
- COCP use
- Breastfeeding
- Pregnancy
Key symptoms of ovarian cancer
- Bloating
- Early satiety
- Loss of appetite
- Pelvic pain
- Hip or groin pain
- Urinary frequency/urgency
- New onset of IBS symptoms/change in bowel habit
Important investigations in Ovarian cancer suspicion
CA125 blood test (>35 IU/mL is significant)
Pelvic ultrasound
What is the criteria for the 2 week wait referral of ovarian cancer
2-week-wait referral if a physical examination reveals:
Ascites
Pelvic mass (unless clearly due to fibroids)
Abdominal mass
What is the risk of malignancy index and what does it measure?
Menopausal status - e.g. post menopausal, perimenopausal, premenopausal
Ultrasound findings
CA125 level
Causes of raised CA125
Endometriosis
Fibroids
Adenomyosis
Pelvic infection
Liver disease
Pregnancy
At what stage is the cancer just confined to the ovary?
stage 1
At what stage has the cancer spread past the ovary inside the pelvis?
stage 2
At what stage has the cancer spread past the pelvis but is inside the abdomen?
stage 3
at what stage has the cancer spread outside of the abdomen?
stage 4: distant metastasis
What type of tumour are women under 40 more likely to present with?
Germ cell tumour - more complex ovarian masses.
Test for:
Alpha-fetoprotein
Human chorionic gonadatropin (HCG)
What is Meig’s syndrome?
Ovarian tumour, usually a fibroma, that has a triad presentation of:
1. Benign ovarian tumour (called Fibroma)
2. Ascites
3. Pleural effusion
