Pathological conference of the Ovary

Question 1

What is the 5 year survival rate for woman with ovarian cancer?

Answer 1

30%

Question 2

In which age group is ovarian cancer most common

Answer 2

> 30 y.o.

Question 3

What are the familial genetic markers which raise a womans risk of having ovarian cancer?

Answer 3

1 - HNPCC/Lynch type II familial cancer syndrome

2 - BRCA1

3 - BRCA2

Question 4

What are the symptoms of ovarian cancer?

Answer 4

They are vague!

1 - Indigestion

2 - Early satiety

3 - Altered bowel habit/pain

4 - Bloating/discomfort/weight pain

5 - Pelvic mass (asymptomatic or pressure symptoms)

Question 5

How is ovarian cancer diagnosed?

Answer 5

• Surgical or pathological
• USS of abdomen and pelvis
• CT Scan
• CA 125 levels will be elevated

Question 6

What is CA 125 and why is it useful in cancer diagnosis?

Answer 6

• A glyco-protein antigen
• It is a useful genetic biomarker that is raised in certain cancers (ovarian, colon, pancreas, breast)

Question 7

How common is a raised CA125 level in woman with ovarian cancer?

Answer 7

80% of woman with ovarian cancer will have an elevated CA125 level

Question 8

What is RMI and how is it calculated?

Answer 8

Risk of Malignancy Index

RMI = U x M x CA 125

U = USS features

M = Menopausal status

CA 125 = value

Question 9

What is the staging criteria for ovarian cancer?

Answer 9

Stage 1 - Limited to ovaries with capsule intact and -ve cytology

Stage 2 - In one or both ovaries with involvement of pelvis

Stage 3 - In one or both ovaries with peritoneal implants or lymph node involvement

Stage 4 - Distant metastasis

Question 10

How is ovarian cancer treated?

Answer 10

Surgery (gold standard) - laparotomy

Chemo (usually better to have surgery 1st then chemo - adjuvant)

Question 11

What role does laparotomy play in ovarian cancer?

Answer 11

1) Obtain tissue diagnosis
2) Stage disease
3) Disease clearance
4) Debulk disease

Question 12

Which woman are considered for ovarian cancer screening?

Answer 12

Those with:

• Cancer gene mutations (CA 125, BRCA1,2)
• 2 or more relatives who have had ovarian cancer

Question 13

What checks are performed as part of screening for ovarian cancer?

Answer 13

1 - Pelvic examination

2 - USS of ovaries

3 - CA 125 blood test

Question 14

What are the cure rates for ovarian cancer stages?

Answer 14

Stage 1 - 85%

Stage 2 - 47%

Stage 3 - 15%

Stage 4 - 10%

Question 15

What chemotherapy drugs are given for ovarian cancer?

Answer 15

Platinum

Taxane

Question 16

What are the USS features in ovarian cancer?

Answer 16

1 - Multi-locular

2 - Solid areas

3 - Bilateral

4 - Metastasis into peritoneum

5 - Ascites