Ovarian tumour (benign and malignant) Flashcards
What are the different types of ovarian tumours?
What is the most common type of ovarian cancer?
Epithelial ovarian cancer (~90% of cases) - develops when there is malignant transformation of the epithelium covering the ovarian capsule and distal fallopian tube
When does ovarian cancer usually occur?
Peak age of incidence is 60 years
Why does ovarian cancer generally carry a poor prognosis?
Due to late diagnosis.
What subtype of ovarian epithelial cancer is most common?
Serous carcinomas
Where is the origin of most ‘ovarian’ cancers?
Distal end of the fallopian tube
What are the risk factors for ovarian cancer?
FH - mutations in BRCA1 and BRCA2
Many ovulations - early menarche, lane menopause, nulliparity
Which medication reduces the risk of ovarian cancer?
COCP -as it reduces the number of ovulations. NB: IVF does not increase risk.
What other factors decrease risk of ovarian cancer?
- Multiparity
- Tubal ligation
- Salpingectomy
- Hysterectomy
What are the clinical features of ovarian cancer?
- abdominal distension and bloating
- abdominal and pelvic pain
- urinary symptoms e.g. Urgency
- early satiety and difficulty eating
- diarrhoea
- other: change in bowel habit, urinary symptoms, back ache, irregular bleeding, fatigue
Most are vague, non-specific symptoms which may cause them to present in late-stage disease. 66% present with stage 3 or later.
O/E: fixed, hard mass arising from pelvis. Ascites makes ovarian cancer likely. Check for lymphadenopathy in groin and neck.
What tumour marker is commonly found in ovarian cancer? When should it be used? What level is significant?
CA125 - should NOT be used in asymptomatic women for screening.
Levels of _>_35 IU/mL mean an urgent scan of the abdomen and pelvis is required
What are the non-malignant causes of a raised CA125?
- Endometriosis
- Menstruation
- Benign ovarian cysts
What investigations should be done for ovarian cancer?
- CA125 - _>_35IU/mL significant and needs USS. Raised in 80% of epithelilal ovarian cancers.
-
USS - characterises the mass in terms of size, consistency, presence of solid elements, bilaterality, ascites, extraovarian disease e.g. peritoneal thickening and omental deposits.
- –> CT/MRI - used for staging and assessing operability
- Laparotomy - usually required for diagnosis
- Paracentesis/pleural aspiration - symptom relief/cytological assessment
Pre-operatively:
- ECG
- CXR
- FBC
- U&E
- LFTs
How is the RMI calculated? What is its use?
The Risk of Malignancy Index (RMI) is calculated from:
- menopausal status,
- pelvic ultrasound features
- CA125
Used to triage pelvic masses into those at low, intermediate and high risk of malignancy.
How is ovarian cancer staged?
FIGO staging system
- 20% present with stage 1
- 10% present with stage 2
- 50% present with stage 3
- 15% present with stage 4