Ovarian tumour Flashcards
What is ovarian tumour
5% of female cancers-
RF - more ovulations
nullparity, early menarche, late menipause
increasing age
HRT
Fhx (BRAC1/2), endometriosis, HNPCC, lynch syndrome, breast cancer
Obesisty, smoking
Most common -70% epithelial origin- most are bening but when malignant-95% are epithelial
types of tumours)
epithelial (70%)- type 1 (low grade (present late, bad prognosis)
serous, endometrioid, mucionous, clear cell (linked with endometriosis)
type 2- high grade serous
Germ cells -15%-
young and older-
teratomas (most common under 30-mature is fine, immature-malignant), dysgeminoma, endodermal sinus, choriocacrinoma)
sex-cord stromal-
fibroma, thecoma, granulosa, sertoli-leydig
assocaite syndromes- peutz jegher, HNPCC, lynch
Meigs- triad of bening ovarian fibroma, ascites adn pleural effusion), cushings
other cancers- metastatic tumours from breast, colon, endometrium
Sx of ovarian tumours
often late presentation - present in FIGO stage 3 (outside pelvis but in abdomen)
adnexal mass and NO pv bleed (ulike endometrial -mass + PMB)
Lower abdo pain, swelling/pressure sx (LUTS, bloating)
deep dyspareunia
Ix of ovarian tumours
1st line is Ca125- over 35 -2ww and TVUSS
TVUSS- ordered by gyne not GP- find size, consistency, bilateraly, ascites, solid elements
calculation of RMI - menopause status x USS stage x CA125
above 250 is high risk
CT > MRI for staging
Mx and complications/prog of ovarian tumours
Surgery and chemotherapy (2nd line - just chemo)
neoadjuvant chemo - platinium based - reassess CT/CA125
use Platinium compounds (cross link DNA- carboplatin), paclitaxel, bevacutiymab (anti VEGF)
surgery - laporatomy -
can consider fertility sparing in young (germ cells)
chemothrapy- not useful for sex cord tumours- always surgery
prog - most important is clearing all during surgery
5y survival - 46% (stage 1 90%, stage 3 -30%)
