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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
when are thromboembolic events seen in advanced ovarian cacer
Especially in clear cell cancer
25
What can para aortic lymph node association cause
Back pain
26
Fruther features of ovarian cacner
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
Why do pregnancy, prolonged breast feeding and high pestrogen pill (esp over 10 years) protect against ovarian ancer
Supressed ovulation - fewer ovulations = lower risk ovarian cancer
28
Familial ovarian caner
BRCA1/2 Lynch syndrome II cancer
29
Incidence of ovarian cancer
50-75 - primarily postmenopausal women
30
What ethnicity has increased rates of ovarian cancer
Women of east european jewish descent 1 in 100 vs 1 in 800 normally chance
31
Types of epithelial ovarian cacner
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
Rare ovarian cancers
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
What cancer cells are sensitivie to PARP inhibitors
Low in oxygen eg fast growing tumours
34
What caners ovarian are BRCA most associated with
Serous Endometroid cancer of ovary
35
BRCA and PALB2 role ovarian cacner
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
Example of PARP inhibitors
Olaparib, rucaparib, niraparib
37
When use PARP inhibtiors
Following first line chemo BRCA mutation carriers Second and third line chemo
38
PARPis MOA
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
Initial investigations for ovarian cncare
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
Why is diagnosis of ovarian cacner laparotomy
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
What is aim of surgery for ovarian cancer
Debulk tu,our volum - >1cm supotimal <1cm optimal or complete
42
Preoperative procedures and when need to be done in ovarian cacnaer
Endometrial smapling if abnormal vaginal bleeding Cytological or histological evaliation of effusions or tumour masses
43
What investigation DO NOT do in ovarian cacner
Paracentesis or needle smapling - can seed new cancer cells and spread cancer further
44
Calculation for risk of malignancy in ovarian cancer
U x M x serum CA-125 U= US features up to 3 Menopausal status - 1 if pre, 3 if post
45
US features of for ovarian cancer risk calculation
Multilocular Solid areas Bilateral Ascites Metastases
46
RMI ovarian cancer parameters for likelihood
<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
What RMI for ovarian cancer prompts gynae referral
>200
48
Progression predication ovarianc cancer
CA125 >25% serial rise
49
What suggests relapse in CA125 levels
Confirmed doubling of upper limit of normal Relapse 100%
50
Role of CA125 in ovarian cnacer detection
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
Markers in ovarian cancer
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
Simplified staging ovarian cancer
I - one ovary II - extension to nearby organs III - abdo cavity involvement IV - widespread, parenchymal liver mets, outside of abdomen
53
Summary of germline BRCA mutations
Inherited mutations in germline cells
54
somatic BRCA muatations
Non germline cells acquired mutataions in already cancerous cells that speed up progression Cant be inherited
55
Surgery for ovarian cancer
laparotomy, total hysterectomy, bilateral salpingo-oopherectomy with omentectomy and lymph node resection.
56
Adjuvant chemo after surgeyr for ovarian cancer
Carboplatin and paclitaxel + bevacizumab if high risk disease
57
When is neoadjuvant chemo used for ovarian cancer
Extensive disease at presentation who may not be suitable for surgery initially - aim of shrinking disease to oconsider interval debulking
58
Relapse in ovarian cancer
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
How id PARP used - dose and how long
Twice daily for 2 yeras Start within 8 weeks of chemotherapy Used in BRCA mutations
60
OVarian cancer disease related complications
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
What complication are ovarian cancer patients at espeically high risk of
DVT/E - prothrombotic disease more than other cancers
62
Poor prognsosis in ovarian cancer
disease resistant to platinum therapy, large volume residual disease following debulking, or clear cell histology
63
BRCA ovarian cancer prognosis
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
What is best prognostic factor in ovarian cancer
Complete cytoreduction in initial surgery
65
10 red falg symptoms fo cancer
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

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