Pathology of the Ovary Flashcards
5 year survival of ovarian cancer of all stages
30%
Usual age range of presentations of ovarian cancer
50s-70s
Under what age is it rare to see ovarian cancer in?
<30s
Genes involved in ovarian cancer in high risk families
HNPCC/Lynch type II familial cancer syndrome
BRCA 1
BRCA 2
BRCA genes type of inheritance
Autosomal dominant inheritance
Lifetime risk of ovarian cancer if have a BRCA gene
15-45%
If have a BRCA gene, what can you develop at a younger age?
Ovarian cancer
Breast cancer
What do BRCA genes do?
They are tumour suppressor genes involved in DNA repair and cell cycle control
Prognosis of family presentations because of mutations
Usually better prognosis as usually present earlier
What is known to be protective of ovarian cancer?
OCP
Possible origins of ovarian cancer
Most cases arise from the fallopian tube rather than the ovary itself
Some derive from pre-existing benign ovarian cysts (often low grade cancers)
Symptoms of ovarian cancer
VAGUE Indigestion/early satiety/poor appetite Altered bowel habit/pain Bloating/discomfort/weight gain Pelvic mass - asymptomatic - pressure symptoms
Investigations of ovarian cancer
USS abdomen and pelvis
CT scan
CA-125
Surgery
What values of CA-125 are normal and what is abnormal?
0-35 = normal >35 = elevated
What is CA-125?
Glyco-protein antigen raised in ovarian cancer but also raised in other things which cause peritoneal irritation e.g. breast and colon cancer and is also especially elevated in pre menopausal women
Conditions where CA-125 would be raised
Malignancy - ovary - breast - colon/pancreas Menstruation/pre menopause endometriosis PID Liver disease Recent surgery Effusions
How many women with ovarian cancer have raised CA-125?
80%
How many women with stage 1 ovarian cancer have raised CA-125?
50%
What is CA-125 used for?
Detecting and monitoring epithelial ovarian tumours
Risk of malignancy index (RMI) of ovarian cancer equation
RMI = U x M x CA 125
Ultrasound features that give a score to U in the RMI in ovarian cancer
Multi-locular Solid areas Bilateral Ascites Intra-abdominal
U score in RMI in ovarian cancer
USS
1 feature = 1
Two to 5 features = 3
M in RMI in ovarian cancer stands for
Menopausal status
M score in RMI in ovarian cancer
Pre menopause = 1
Post menopause = 3
Staging of ovarian cancer
Stage 1 = limited to ovaries with capsule intact +/- cytology
Stage 2 = one or both ovaries with pelvic extension
Stage 3 = One or both ovaries with peritoneal implants outside pelvis or + nodes
Stage 4 = distant metastases
Treatment of ovarian cancer
- Surgery (laparotomy)
2. Chemotherapy (within 8 weeks of surgery)
In what stage of ovarian cancer is a cure unlikely with chemotherapy?
3rd/4th stage
Cure rates of the stages of ovarian cancer
1 = 85% 2 = 47% 3 = 15% 4 = 10%
What stages of ovarian cancer do most women present with?
stage 3 or stage 4
What can advanced ovarian cancer be seen as?
A chronic disease as it will relapse and have to be treated again
When is screening for ovarian cancer carried out?
High risk women
- cancer gene mutation carriers
- 2 or more relatives
What is used to screen high risk women for ovarian cancer?
Pelvic exam
USS of ovaries
CA-125
What preventative measure can high risk women carry out if they are high risk for ovarian cancer?
Prophylactic oophorectomy and salpingectomy
Nice guidelines state that serum CA125 should be performed in a woman (esp if > 50 y/o) if they have which symptoms on a regular basis?
Abdominal distention (or bloating)
Early satiety or loss of appetite
Pelvic or abdominal pain
Increased urinary urgency / frequency
How does ovarian cancer initially spread?
Local invasion
Is there currently a screening programme for ovarian cancer in the UK?
No
What are granulosa cell tumours of the ovary associated with?
Development of endometrial hyperplasia
Most common type of ovarian pathology associated with meigs syndrome
Fibroma
Features of meigs syndrome
Benign ovarian tumour (usually fibroma)
Ascites
Pleural effusion
Most common benign ovarian tumour in women < 25 y/o
Dermoid cyst (teratoma)
Most common cause of ovarian enlargement in women of reproductive age
Follicular cyst
