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Cancer > Ovarian cancer - look at 3rd year! > Flashcards

Ovarian cancer - look at 3rd year! Flashcards

1
Q

Risk factors for ovarian cancer

A

Mutations of BRCA 1/2
Many ovulations = early menarche, late menopause, nulliparity

COCP and many pregnancies reduce the risk

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2
Q

Clinical features ovarian cancer

A

Vague
Abdo distension and bloating
Abdo and pelvic pain
Urinary symptoms eg urgency, polyuria
Early satiety, feeling full
Lump in pelvic area
GI problems - gas, bloating, constipation, diarrhoea

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3
Q

Initial investgiation ovarian cancer

A

CA125 blood test

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4
Q

What can cause a raised CA125

A

endometriosis
Menstruation
benign ovarian cysts
Ovarian cancer

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5
Q

What do if CA125 raised

A

Urgent abdo pelvic ES
if CA125 >35

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6
Q

What aids diagnosis

A

Diagnostic laparatomy

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7
Q

Prognosis of ovarian cacner

A

Often poor due to late presentaton
Highly correlated to stage at presnetation
High grade seroud cancer poorer prognosis than other histology
Patients performance status
Older ad comorbidities
Amount of residual disease after surgeyr
Molecular and genetic factors

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8
Q

Performance status assessments

A

Eastern Cooperative Oncology Group (ECOG) scale or the Karnofsky Performance Scale (KPS),

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9
Q

FIGO stage and five year survival rate

A

II - 60-80%
III 0 30-60%
IV - 10-25%

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10
Q

High grade serous vs other hisotlogy surivval rates and residual disease survival rates

A

High grade serous - 35-45%
Other histology - 55-85%
No residual disease - 70-90%
Residual disease >1cm 30-50%

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11
Q

How does performance status affect survivability from ovarian cancer

A

ECOG 0-1/KPS 80-100 = 60-85%
ECOG 2-4/KPS <8-0 = 20-40%

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12
Q

Ovarian germ cell tumours progression

A

Grow rapidly - uration of symptoms before present usually 2-4 weels

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13
Q

Retroperitoneal tumours why present late

A

Can expand without acutely obstrucitng vital organs
Present with abdo mass and abdo or back pain

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14
Q

How can preserve sperm before treatment for testicular cancer

A

Sperm cryopreservation

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15
Q

Why do germ cell cancers respond so well to chemo/readiotherapy

A

Extremely rapidly dividng cells

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16
Q

How mayn ovarian malignancies are germ cell tumours

A

3-5%

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17
Q

Which population do ovarian germ cell tumours occur in

A

young women and adolescent girls

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18
Q

Treatment of ovarian germ cell tumours

A

Cytoreductive surgery w preservation of fertility where possible
Unilateral SO omentectomy, peritoneal washings and detailed inspections abdominal vacity
Biopsies for staging, pelvic and para aorti lymph nodes biopsied if suspicious
BOS preformed if bilarerally abnormal - more common in dysgerminoma
Post op chemo 3 cycles BEP
4 cycles if bulky

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19
Q

Extra gonodal tumours treatment

A

Extra-gonadal GCTs are treated dependent upon the site and histological type of tumour. Seminomas are chemotherapy and radiotherapy sensitive, whereas non-seminomas are less so and chemotherapy is given post surgery. For mediastinal and retroperitoneal tumours BEP chemotherapy and surgery are treatments of choice. In intracranial tumours, radiotherapy is given alone in seminoma and in combination with chemotherapy in non-seminoma. Surgery may remove residual mass after chemotherapy but carries a risk of spinal metastases.

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20
Q

What is RPLND

A

Retroperitoneal lymph node dissection

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21
Q

Annual mortality rate of ovarian cancer vs incidence rate

A

65% of ovarian cancer patients die within a year
d 6,850 new cases of this cancer will be diagnosed in the UK each year
In the UK, 4,690 women will die of ovarian cancer per year and the number of deaths from ovarian cancer continues to increase
1 in 100 women will die of ovarian cancer

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22
Q

What cancers can cause the sister mary joseph nodule present and what is it

A

Palpable nodule near umbilicus
Gastrointestinal Cancers: Such as stomach, colon, or pancreatic cancer.
Gynecological Cancers: Including ovarian, uterine, or cervical cancer.

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23
Q

What is transcoloeimc spread of cancer

A

Peritonneal spread through cavity via peritonneal fluid

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24
Q

What is peritoneal carcinomatosis

A

Massive involvement of peritonneum in cancer spread

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25
Q

when are thromboembolic events seen in advanced ovarian cacer

A

Especially in clear cell cancer

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25
Q

What can para aortic lymph node association cause

A

Back pain

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26
Q

Fruther features of ovarian cacner

A

Constitutional: fatigue, anorexia
Bowel: abdominal bloating or distension, loss of appetite, nausea, vomiting, altered bowel habit, esp. constipation, abdominal pain, bowel obstruction
Kidney: hydronephrosis secondary to ureteric obstruction, haematuria, recurrent UTI, loin pain, renal failure
Pleural effusion: breathlessness, respiratory distress (rare) as a result of a large pleural effusion, which is more common on the right
Thromboembolic phenomenon in advanced, esp clear cell cancer of the ovary
umbilical peritoneal deposits are seen as Sister Mary Joseph nodules indicating transcoelomic spread and stage 4 disease.

27
Q

Why do pregnancy, prolonged breast feeding and high pestrogen pill (esp over 10 years) protect against ovarian ancer

A

Supressed ovulation - fewer ovulations = lower risk ovarian cancer

28
Q

Familial ovarian caner

A

BRCA1/2
Lynch syndrome II cancer

29
Q

Incidence of ovarian cancer

A

50-75 - primarily postmenopausal women

30
Q

What ethnicity has increased rates of ovarian cancer

A

Women of east european jewish descent
1 in 100 vs 1 in 800 normally chance

31
Q

Types of epithelial ovarian cacner

A

Serous (46%): Fallopian tube epithelium – majority of tumours
Mucinous (35%): GI tract or endocervical epithelium
Endometrioid (8%): Proliferative endometrium
Clear cell (3%): Gestational endometrium – relatively rare, aggressive, CA-125 often not raised in this type
Squamous cell (<1%)
Transitional cell (Brenner): Urinary tract epithelium (rare)

32
Q

Rare ovarian cancers

A

Germ cell tumours
Carcinosarcomas - aggressive + more susceptible to haematogenous spread
Sex cord trumours incl granulosa cell tumours, thecomas, sertoli-leydig cell tumours and gonadoblastomas
May produce oestrogens -> pre pubert and post menipausal bleeding, androgens -> virilisation

33
Q

What cancer cells are sensitivie to PARP inhibitors

A

Low in oxygen eg fast growing tumours

34
Q

What caners ovarian are BRCA most associated with

A

Serous
Endometroid cancer of ovary

35
Q

BRCA and PALB2 role ovarian cacner

A

BRCA1, BRCA2 and PALB2 are proteins important for the repair of double-strand DNA breaks by the error-free homologous recombination repair (HRR) pathway

36
Q

Example of PARP inhibitors

A

Olaparib, rucaparib, niraparib

37
Q

When use PARP inhibtiors

A

Following first line chemo BRCA mutation carriers
Second and third line chemo

38
Q

PARPis MOA

A

PARP1 is a protein that is important for repairing single-strand breaks (‘nicks’ in the DNA)
If such nicks persist unrepaired until DNA is replicated (which must precede cell division), then the replication itself can cause double-strand breaks to form
Drugs that inhibit PARP1 cause multiple double-strand breaks to form, and in tumours with BRCA1, BRCA2 or PALB2 mutations these double-strand breaks cannot be efficiently repaired, leading to the death of the cells
Normal cells that do not replicate their DNA as often as cancer cells and that lacks any mutated BRCA1 or BRCA2 still have homologous repair operating, which allows them to survive the inhibition of PARP

39
Q

Initial investigations for ovarian cncare

A

Complete medical history and examination
Full blood count
Serum biochemistry
Liver function
Bone profile
Tumour markers: CA-125, CEA, and in younger women: hCG, AFP, LDH (in view of risk of germ cell malignancy)

40
Q

Why is diagnosis of ovarian cacner laparotomy

A

Initial treatment is to remove cancer and determine extent of spread therefore diagnostic and treatment in one
Histopathological diagnosis after exploraatory laparatomy
Staging done this way

41
Q

What is aim of surgery for ovarian cancer

A

Debulk tu,our volum - >1cm supotimal
<1cm optimal or complete

42
Q

Preoperative procedures and when need to be done in ovarian cacnaer

A

Endometrial smapling if abnormal vaginal bleeding
Cytological or histological evaliation of effusions or tumour masses

43
Q

What investigation DO NOT do in ovarian cacner

A

Paracentesis or needle smapling - can seed new cancer cells and spread cancer further

44
Q

Calculation for risk of malignancy in ovarian cancer

A

U x M x serum CA-125

U= US features up to 3
Menopausal status - 1 if pre, 3 if post

45
Q

US features of for ovarian cancer risk calculation

A

Multilocular
Solid areas
Bilateral
Ascites
Metastases

46
Q

RMI ovarian cancer parameters for likelihood

A

<25 = low risk, <3 %
25-250 = moderate risk - 20% have cancer
>250 = high risk = 75% cancer chance

40% low, 30% mod, 30% high risk that get referred

47
Q

What RMI for ovarian cancer prompts gynae referral

A

> 200

48
Q

Progression predication ovarianc cancer

A

CA125 >25% serial rise

49
Q

What suggests relapse in CA125 levels

A

Confirmed doubling of upper limit of normal
Relapse 100%

50
Q

Role of CA125 in ovarian cnacer detection

A

50% of those with early disease have raised CA125
present at cell surface in >80%non mucinous epithelial ovarian tumurs
V high levels before surgery -> worse prognosis

51
Q

Markers in ovarian cancer

A

CA125
CASA, OVX1, HMFG2 - breast carcinoma ass mucins
Cytokeratin proliferation markers - tissue PP antigen, placental ALP, TATI, CA 19.9, TAG 72.3, LASA, IAP, CSF, ferritin, NB/70K, galactosyl tranferase
Non as yet clinically useful as much as CA125
AFP, beta hCG for germ cell tumours

52
Q

Simplified staging ovarian cancer

A

I - one ovary
II - extension to nearby organs
III - abdo cavity involvement
IV - widespread, parenchymal liver mets, outside of abdomen

53
Q

Summary of germline BRCA mutations

A

Inherited mutations in germline cells

54
Q

somatic BRCA muatations

A

Non germline cells acquired mutataions in already cancerous cells that speed up progression
Cant be inherited

55
Q

Surgery for ovarian cancer

A

laparotomy, total hysterectomy, bilateral salpingo-oopherectomy with omentectomy and lymph node resection.

56
Q

Adjuvant chemo after surgeyr for ovarian cancer

A

Carboplatin and paclitaxel + bevacizumab if high risk disease

57
Q

When is neoadjuvant chemo used for ovarian cancer

A

Extensive disease at presentation who may not be suitable for surgery initially - aim of shrinking disease to oconsider interval debulking

58
Q

Relapse in ovarian cancer

A

High - 60% of patients with ovarian caner relapse at some point
Reduced response to chemotherapy
Can use tamoxifen or aromatase inhibitors to slow rate of progression and symptoms onset

59
Q

How id PARP used - dose and how long

A

Twice daily for 2 yeras
Start within 8 weeks of chemotherapy
Used in BRCA mutations

60
Q

OVarian cancer disease related complications

A

Local invasion
Lymphoedema
Vaginal discharge
Bowel obstruction
Ascites (may need paracentesis(
pleural effusion (talc pleurodesis can reduce recurrence)
Hhydronephrosis - ureteric obstruction

Distant metastasis
Liver, lung, bone, brain

Non-metastatic
Pulmonary emboli
Dermatomyositis

61
Q

What complication are ovarian cancer patients at espeically high risk of

A

DVT/E - prothrombotic disease more than other cancers

62
Q

Poor prognsosis in ovarian cancer

A

disease resistant to platinum therapy, large volume residual disease following debulking, or clear cell histology

63
Q

BRCA ovarian cancer prognosis

A

BRCA gene mutations are more likely to have visceral metastasis, but equally are more likely to respond to platinum therapy and have longer treatment-free intervals.

64
Q

What is best prognostic factor in ovarian cancer

A

Complete cytoreduction in initial surgery

65
Q

10 red falg symptoms fo cancer

A

Persistent cough or hoarseness – could indicate lung cancer

A change in the appearance of a mole – could mean you’re suffering skin cancer

A persistent change in bowel habits – could be a sign of bowel cancer

A sore that does not heal – depends on where, a mouth ulcer could mean mouth cancer

Persistent difficulty swallowing – can mean a person is suffering oesophageal cancer

Unexplained weight loss – can indicate several types of cancer

Persistent change in bladder habits – could be a sign of bladder cancer and prostate cancer in men

An unexplained lump – can be a warning sign of many forms of the disease

Persistent unexplained pain – depending on where, can denote many types of cancer

Unexplained bleeding – depends where but can mean bowel, cervical or vulval cancer

Cancer (22 decks)

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