Pathology of the ovary and endometrium

Question 1

Ovarian Cancer Symptoms

Answer 1

• Vague
• Indigestion/early satiety/poor appetite
• Altered bowel habit/pain
• Bloating/discomfort/weight gain
• Pelvic mass
  - asymptomatic
  - pressure symptoms

Question 2

Ovarian Cancer Diagnosis

Answer 2

• Surgical/pathological
• USS abdomen and pelvis
• CT Scan
• CA 125

Question 3

CA 125

Answer 3

• glycoprotein antigen
• 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

Question 4

Why may a CA 125 be raised?

Answer 4

• Malignancy
  - ovary
  - colon/pancreas
  - breast
• Benign conditions
  - menstruation/endometriosis/PID
  - liver disease/recent surgery/effusions

Question 5

Ovarian cancer staging

Answer 5

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 + nodes
4) distant metastasis

Question 6

Ovarian Cancer Treatment

Answer 6

• Surgery
• Chemotherapy
  - Adjuvant
  - Neo-adjuvant

Question 7

Ovarian Cancer Laparotomy

Answer 7

• Obtain tissue diagnosis
• Stage disease
• Disease clearance
• Debulk disease

Question 8

Ovarian Cancer Chemotherapy

Answer 8

• First line Platinum and taxane (Taxol)
• Within 8 weeks of surgery
• Complete/partial response
• Cure unlikely
• Average response 2 years

Question 9

Ovarian cancer screening

Answer 9

• Not recommended
• Limited sensitivity and specificity
• Pelvic examination
• US scanning of ovaries
• CA 125

Question 10

Symtoms of endometrial cancer

Answer 10

• Abnormal vaginal bleeding

- Post menopausal bleeding (PMB)

Question 11

Risk factors for endometrial cancer

Answer 11

• Post-menopausal women
• High circulating oestrogen levels
  - obesity
  - unopposed E2 therapy/Tamoxifen
  - Polycystic ovarian syndrome (PCOS)
  - early menarche/late menopause
• Atypical endometrial hyperplasia
• HNPCC/Lynch type II familial cancer syndrome

Question 12

Causes of post menopausal bleeding

Answer 12

• 8% of women with PMB will have endometrial cancer
• Hormone Replacement Therapy (HRT)
• Peri-menopausal bleeding
• Atrophic vaginitis
• Polyps cervical/endometrial
• Other cancer eg cervix, vulva, bladder, anal

Question 13

Endometrial cancer investigations

Answer 13

• Trans-vaginal scan to look at endometrial thickness and contour
• Diagnosis by histology of endometrium

Question 14

Endometrial Cancer Staging

Answer 14

• Surgical/Pathological
• MRI
  - depth of myometrial invasion
  - cervical involvement
  - lymph node involvement

Question 15

Endometrial cancer treatment

Answer 15

• Early Stage
  - Surgery (Total abdominal hysterectomy-bilateral salpingo-oophorectomy) TAH BSO
• High risk histology
  - Chemotherapy
• Advanced Stage
  - Radiotherapy
• Palliation
  - Progesterone