Ovary

Question 1

epidemiology

Answer 1

more common in white females
58% have advanced disease
4% of all cancers in females

Question 2

what are the protective measures

Answer 2

pregnancy
breast feeding
high parity
oral contraceptive: reduce the number of ovulations
late menarch and early menopause

Question 3

aetiology

Answer 3

long term trauma to the ovary
early menarche and late menopuase
diabetes
infertility or nullipartility
hormone replacement therapy
obesity
smoking
endometriosis
family history
genetics: BRCA 1/2 mutations, lynchs syndrome

Question 4

what is the most common pathology

Answer 4

epithelial 85% (arises from surface epithelial, it can either be cystic or solid)

Question 5

what is the other pathology type

Answer 5

germ cell: dysgerminsomas, teratomas and sex cord and granulose cell tumours

Question 6

symptoms

Answer 6

persistent bloating
difficulty eating, feeling full quickly
abdominal, pelvic pain
frequency and urgency
loss of appetite
nausea
weight change
abnormal vaginal bleeding
pain during sex
changes in bowel and bladder habits
breathlessness

Question 7

investigation

Answer 7

PV clinical examination to feel abnormalities in the ovaries
transvaginal ultrasound to visualise ovaries
blood tests: FBC, LFT, U&E
test for CA 125 cancer antigen protein which is produced by ovarian tumours, if this is higher further tests are needed. If the tumour does produce this, it can be monitored and its treatment response.

Question 8

what does CT and MRI do?

Answer 8

extent of local and nodal spread

Question 9

transcoelomic spread

Answer 9

through the peritoneum, spread through the abdomen, may cause ascites

Question 10

FIGO staging system

Answer 10

stage I = confined in the ovary
IA = 1 ovary involved
IB = both involved
IC = peritoneal cytology +/ capsule ruptured/ cells on the ovary surface
stage II = one or both pelvic extension
stage III = one or both spread to the abdominal cavity/ peritoneal deposits
stage IV = blood borne mets

Question 11

how is IA + IB managed

Answer 11

total abdominal hysterectomy + bilateral salpingo-oopharectomy

Question 12

how is IC managed

Answer 12

adjuvant chemo with cis platinum to carbo after surgery

Question 13

how is stage II & III managed

Answer 13

surgery + chemo: cis or carbo + paclitaxel, neoadjuvant may be given to reduce tumour volume before resection

Question 14

how is IV managed

Answer 14

palliative treatment (same as II + III), RT can be offered

Question 15

what is palliative RT

Answer 15

symptom control
POP
low dose and fraction, 20Gy in 5

Question 16

ovarian tetratoma

Answer 16

benign or malignant
if malignant it is only fairly chemo sensitive

Question 17

sex cord and granulosa

Answer 17

produce hormones so tend to present early, treatment is TAH + BSO, if unaffected the ovary can be persevered. These tend come back with intra-abdominal met which can occur 30 years after initial diagnosis

Question 18

what is dysgerminoma

Answer 18

present at an early stage which is when there is enlargement in the abdomen and pain. Treatment is surgery, with a good prognosis.
CHEMOSENSITIVE