pathology of ovaries

Question 1

Ovarian cancer

Answer 1

•	High risk families 5-10% of cases
o	HNPCC/Lynch type II familial cancer syndrome
o	BRAC1
o	BRAC2
•	‘Incessant ovulation’
•	OCP protective

Question 2

diagnosis

Answer 2

o CA 125
♣ Glyco-protein antigen
♣ Indicator of certain malignancies
• Ovary, colon/pancreas, breast
♣ Benign conditions
• menstruation/endometriosis/PID
• liver disease/recent surgery/effusions
♣ 80% of women with ovarian cancer have a raised CA 125
• 50% of women with stage 1 disease
♣ Used in detecting and monitoring epithelial ovarian tumours
• Serous epithelial ovarian cancer is the most common type

Question 3

treatment

Answer 3

surgery
-laparatomy
chemotherapy
-platinum and taxane

Question 4

screening

Answer 4

o	High risk women
♣	cancer gene mutation carriers
♣	2 or more relatives
o	Pelvic examination
o	US scanning of ovaries
o	CA 125
o	Prophylactic oophorectomy for high risk women (removal of tubes and ovaries)

Question 5

investigations

Answer 5

pelvic and speculum examination
♣ Endometrial should be thin post menopause
• Post menopause; low oestrogen levels. Oestrogen increases vascularity
epithelium thinner, more easily damaged & spontaneously bleed
Look at the endometrial conto
• Pathological prognostic features
1) Histological type
♣ Type 1 or type 2 carcinoma
• Type 1 – endometrioid adenocarcinomas 95%
o Linked to excess oestrogen levels
o Hyperplasia with atypia precursor
• Type 2 – uterine serous carcinomas and clear cell carcinomas
o Not linked to excess oestrogen levels
o High grade, more aggressive, worse prognosis
o Generally older ladies
Serous intraepithelial carcinoma precursor

Question 6

endometrial cancer staging

Answer 6

♣ Stage 1a Inner half of myometrium
♣ Stage 1b Outer half of myometrium
♣ Stage 2 Invades cervix
♣ Stage 3a Serosa/adnexa
♣ Stage 3b Vagina/parametrium (tissues on the side of the uterus: broad ligament, etc)
♣ Stage 3c Pelvic or para-aortic nodes
♣ Stage 4 Bladder/bowel/intra-abdominal/inguinal nodes