Ovarian Tumours Flashcards
Types of ovarian tumours
Epithelial
Germ cell
Sex cord/stromal
Metastatic
Where do metastatic ovarian tumours come from?
GI tract
Breast
Pancreas
Endometrium
Features of metastatic ovarian tumours
Bilateral and small
Presentation of ovarian cancer
Presents late Non-specific symptoms Bloating Early satiety New onset IBS >50 = think about ovarian cancer Ascites
Peak age of ovarian cancer
75
Risk factors for ovarian cancer
↑Number of ovulations: early menarche, late menopause, nulliparity
Genetics: family history (relative <50yrs), Lynch syndrome, BRCA1, BRCA2
Endometriosis
Protective factors against ovarian cancer
COC
Breastfeeding
Pregnancy
Investigations for ovarian cancer
CA125 (is raised in 80% of ovarian cancers) Pelvic ultrasound CA125:CEA RMI (risk of malignancy index) CXR/CT
What is CA125:CEA ratio used for?
Higher ratio (>30) = more likely to be ovarian origin Lower ratio (<30) = primary elsewhere (e.g. GI)
How do you calculate RMI?
CA125 level x US score x menopausal score
Where can ovarian cancer spread?
Peritoneum Para-aortic nodes Liver Lungs Bone Brain Greater omentum (epithelial cancer spread)
Treatment of ovarian cancer
Surgery + adjuvant chemotherapy
debulking surgery + carcoplatin + paclitaxel
What additional tests are done in women <40 with suspected ovarian cancer?
Additional tumour markers to look for germ cell tumours:
alpha foeto-protein
LDH (serum lactic dehydrogenase)
hCG
Why is chemotherapy not used for borderline ovarian tumours?
Because they are slow growing
What are the characteristics of borderline ovarian tumours?
Does not invade the stroma but has malignant characteristics
Types of epithelial ovarian tumours
Serous Endometrioid Clear cell Mucinous Urothelial-like/Brenner
Types of serous carcinoma
High grade serous carcinoma
Low grade serous carcinoma
Precursor for high grade serous carcinoma
Serous tubal intraepithelial carcinoma
Precursor for low grade serous carcinoma
Serous borderline tumour
What ovarian cancers are associated with ovarian endometriosis and Lynch syndrome?
Endometroid
Clear cell
What is the most common ovarian cancer?
Serous carcinoma
Which epithelial ovarian tumours are often benign?
Mucinous
Urothelial-like/Brenner
What age group do germ cell ovarian tumours commonly affect?
Affect children/young women
Types of germ cell ovarian tumours
Mature cystic teratoma (dermoid cyst) Immature teratoma Dysgerminoma Yolk sac/endodermal sinus tumour Choriocarcinoma
