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Reproductive System > Pathologies of the Ovaries > Flashcards

Pathologies of the Ovaries Flashcards

1
Q

What is the five year survival rate for ovarian cancer?

A

30% for all stages

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2
Q

Where does ovarian cancer originate?

A

Most probably originate in fallopian tubes

Some derive from pre-existing benign ovarian cysts, but these are often low grade cancers

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3
Q

What is the most common cancer of the ovaries?

A

High grade serous carcinoma

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4
Q

What is the epidemiology of ovarian cancer?

A
  • Rare <30
  • High risk families make up 5-10% of cases (HNPCC, lynch syndrome, BRCA1/2)
  • Peak incidence 50s-60s (High risk families tend to present around a decade earlier)
  • Pregnancy, breast feeding and the oral contraceptive pill are all protective against ovarian cancer as the ovaries are dormant
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5
Q

What are the symptoms of ovarian cancer?

A

Often vague, including:
•Indigestion, early satiety, poor appetite
•Altered bowel habit, pain
•Bloating, discomfort, weight gain
•Pelvic mass (may be asymptomatic or can give pressure symptoms)

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6
Q

What modalities can be involved in the diagnosis of ovarian cancer?

A
  • Surgical/Pathological
  • US Scan abdomen and pelvis
  • CT Scan
  • CA 125
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7
Q

What conditions can cause a raised CA 125?

A
  • Malignancy of the ovary, breast, colon or pancreas
  • Menstruation
  • Endometriosis
  • Pelvic inflammatory disease
  • Liver disease
  • Recent surgery
  • Effusions
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8
Q

How is CA 125 used in ovarian cancer?

A

80% of women with ovarian cancer will have a raised CA 125

Used to detect and monitor epithelial ovarian cancers

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9
Q

What is an RMI and how is it calculated?

A 
Risk of malignancy index
RMI=U ×M ×CA 125
Where U= ultrasound features, with one point being allocated to each of the following:
	-multi-locular
	-solid areas
	-bilateral 
	-ascites
	-intra-abdominal
M= menopausal status, where pre-menopausal = 1 point and post-menopausal = 3. Post-menopausal in this instance is taken as >1year amenorrhoeic or >50 years old if surgical hysterectomy has been done. CA 125 corresponds to the CA 125 level.
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10
Q

How is ovarian cancer staged?

A

1- Limited to ovaries with capsule intact
2- One or both ovaries with pelvic extension
3- One or both ovaries with peritoneal implants outside pelvis or with nodes
4- Distant metastases

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11
Q

What is an omental cake?

A

When there are tumour deposits on the surface of the omentum. If this is present then the omentum will need removed

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12
Q

What are the basis of treatment in ovarian cancer?

A

Surgery and chemotherapy (adjuvant or neo-adjuvant)

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13
Q

What are the possible uses of a laparotomy in ovarian cancer?

A
  • Obtain tissue diagnosis
  • Stage disease
  • Disease clearance
  • Debulk disease (aim to get deposits down to <1cm to increase effectiveness of chemotherapy)
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14
Q

How is chemotherapy used in ovarian cancer?

A

Chemotherapy in ovarian cancer is platinum and taxane as first line. The aim is to give this within eight weeks of surgery, but a cure is unlikely unless stage 1.

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15
Q

What are the cure rates associated with ovarian cancer?

A
  • Stage 1- 85%
  • Stage 2- 47%
  • Stage 3- 15%
  • Stage 4- 10%
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16
Q

What options are available in cases of recurrent ovarian cancer?

A
  • Chemotherapy
  • Palliation
  • Platinum if >6 months since previous chemotherapy
  • Potential for surgery
  • Tamoxifen- hormonal treatment
17
Q

Why is population screening for ovarian cancer not indicated?

A

No pre-cancerous stage to detect

18
Q

When is screening for ovarian cancer offered and how is it done?

A

Offered to high risk women (cancer mutation gene carrier, 2 or more relatives with ovarian cancer)
Done with pelvic examination, ultrasound or CA 125

19
Q

When would a prophylactic oopherectomy be offered?

A

To high risk women at age 40-45 as they will likely be finished having children

20
Q

What risk is there after an oopherectomy?

A

Residual risk of primary peritoneal cancer

21
Q

What are the characteristics of a benign ovarian cyst?

A

Smooth surface

Single lobe

22
Q

What are the characteristics of a borderline ovarian cyst?

A 
Most common in younger women
Multi-lobullated
Papillary-like areas
Can progress to malignancy
Can be cured

Reproductive System (30 decks)

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