Ovary Flashcards
epidemiology
more common in white females
58% have advanced disease
4% of all cancers in females
what are the protective measures
pregnancy
breast feeding
high parity
oral contraceptive: reduce the number of ovulations
late menarch and early menopause
aetiology
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
what is the most common pathology
epithelial 85% (arises from surface epithelial, it can either be cystic or solid)
what is the other pathology type
germ cell: dysgerminsomas, teratomas and sex cord and granulose cell tumours
symptoms
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
investigation
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.
what does CT and MRI do?
extent of local and nodal spread
transcoelomic spread
through the peritoneum, spread through the abdomen, may cause ascites
FIGO staging system
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
how is IA + IB managed
total abdominal hysterectomy + bilateral salpingo-oopharectomy
how is IC managed
adjuvant chemo with cis platinum to carbo after surgery
how is stage II & III managed
surgery + chemo: cis or carbo + paclitaxel, neoadjuvant may be given to reduce tumour volume before resection
how is IV managed
palliative treatment (same as II + III), RT can be offered
what is palliative RT
symptom control
POP
low dose and fraction, 20Gy in 5