Pelvic masses and ovarian cancer Flashcards
What are risk factors for the development of ovarian cancer?
- BRCA1/2
- HNPCC
- Early menarche/Late menopause
- Previous breast cancer
- Asbestos
- Nulliparity
- Smoking
- Obesity/Diabetes
- “Incessant ovulation”
What factors protect against the development of ovarian cancer?
- Pregnancy
- Breastfeeding
- COCP
- Tubal ligation
- Hysterectomy
- Exercise
- Aspirin
When would you consider referring someone for genetic counselling if the had ovarian cancer?
- Two primary cancers in one 1st/2nd degree relative
- Three 1st/2nd degree relatives with breast, ovary, colorectal, stomach or endometrial cancers
- Two 1st/2nd degree relatives - 1 with ovarian cancer any age, and other with breast cancer age < 50
- Two 1st/2nd degeree relative with ovarian cancer any age
How does ovarian cancer present?
Often vague symptoms:
- Bloating
- Unexplained weight loss/Loss of appetite/early satiety
- Fatigue
- Urinary symptoms - Frequency/urgency
- Change in bowel habits
- Abdominal/Pelvic pain
- Vaginal bleeding
- Pelvic mass
What can ovarian cancer present like?
- IBS
- Diverticular disease
What might you find on examination in someone with ovarian cancer?
- Fixed abdominal/pelvic mass
- Ascites
- Omental mass
- Pleural effusion
- Supraclavicular lymphadenopathy
What are the main types of ovarian tumours?
- Epithelial
- Germ cell
- Sex cord-stromal
- Metastatic
- Miscellaneous
Where do epithelial cell tumours arise from?
Mesothelial layer covering the peritoneal surface of the ovary and associated inclusion cysts
What are different types of epithelial ovarian cancers?
- Serous
- Mucinous
- Endometroid
- Clear cell
- Brenner
- Mixed epithelial
- Mixed mullerian
What are the different types of germ cell malignancies seen in ovarian cancers?
- Dysgerminoma
- Teratoma
- Yolk sac tumour
- Choriocarcinoma
What are the different types of sex cord-stromal tumours?
- Thecoma
- Granulosa cell tumour
- Androblastoma
- Gonadoblastoma
- Fibroma
What investigations would you consider doing in someone with suspected ovarian cancer?
- Examine Abdo and Pelvis
- Bloods - FBC, U+E’s, LFTs, CA-125, CA 19-9, AFP, BHCG, placental ACP, LDH, serum inhibin
- Imaging - Pelvic US, CXR, CT abdo/pelvis, MRI
- Other - ascitic tap/pleural tap, biopsy
What might you see on pelvic USS in someone with ovarian cancer?
Presence of solid, complex, septated, multi-loculated mass, with high blood flow
When would transvaginal ultrasound be used when investigating ovarian cancer?
If pelvic mass palpated on examination
What is CA-125?
Glyco-protein used in detecting and monitoring epithelial ovarian tumours
What proportion of epithelial cancers is CA-125 positive in?
80%
What else can elevate CA-125?
- Endometriosis
- Uterine fibroids
- Pregnancy
- Ovarian cysts
- Pancreatic, breast, lung, gastric and colon cancer
How would you make the diagnosis of ovarian cancer?
- Extirpation of affected ovary
- Pleural/ascitic fluid aspiration
Why might you do CXR in someone with suspected ovarian cancer?
- Look for pleural effusion, lung mets
- Used in staging
How is the risk of malignancy index calculated?
US x M x CA125
- US = US score (1-3)
- M = Menopausal status (1 - pre, 2-peri, 3 - post)
- CA125 = serum CA125 levels