The treatment of ovarian cancer

Question 1

What group is high risk for ovarian cancer? (5)

Answer 1

>50 yrs
nulliparity (or low parity)
delayed pregnancy 
fam hx breast/ovarian cancer
BRCA1, BRCA2

Question 2

Presentation

• presents when?
• symptoms?
• investigations? (4)
• Us findings (5) and scoring?

Answer 2

-late stage

-ascites/bloating
early satiety 
Pelvic mass/bladder dysfunction
Pleural effusion/SOB
incidental finding

-CA125 blood test
USS- transvaginal/abdominal
Cytology-pleural fluid/ascities
pathology

-multilocular cyst, solid areas, Bilateral lesions, ascites, intrabdo mets
RMI score = Us+ menopausal score+ CA125, if >200 then refer

Question 3

Staging using FIGO

• I
• II
• III
• IV

Answer 3

I- confined to one or both ovaries

II- spread to other pelvic organs

III- spread beyond the pelvis within the abdomen

IV- spread into other organs

Question 4

patterns of spread:

• most common?
• rare?

Answer 4

• transcoelomic spread/peritoneal seeding within pelvis and into abdo cavity
• heamatogenous spread to liver, lungs, brain is late and rare

Question 5

pathology

-most common?

Answer 5

epithelial tumours of the ovary:

serous, mucinous, endometrioid, clear cell, undifferentiated

Question 6

Treatment
what are the options for treatment of epithelial cell tumour? (3)
-early disease?
-late disease?
-residual disease?
-chemo used? (2)
-pattern of disease?
-relapsed disease?
What are the treatment options for serous, clear cell and mutinous tumours?

Answer 6

surgery 
(TAH, BSO, omentectomy, optimal debulking)
surgery and chemo
(neoadjuvant chemo used in stage 3
chemo and surgery

-fertility conserving surgery is an option there is disease only on one ovary and there is no evidence of omental or peritoneal disease
adjuvant chemo should be considered

-aim is too achieve complete cytoreduction
neoadjuvant chemotherapy
use a platinum agent: carboplatin
Paclitaxel can be used along with carboplatin post surgery but is more toxic

• intraperitoneal chemo when less than 1cm
• carboplatin/paclitaxel but relapse rate is high
• can become chronic with lots of attempted chemo before it becomes resistant

-platinum sensitive:
platinum based combo e.g. paclitaxel, PLDH or gemcitabine
Platinum resistant:
hormonal therapy with tamoxifen

clinical trials for chemo if lower grade but these are less responsive to chemo

Question 7

Type of ovarian cancer associated with the BRCA1 gene?

Answer 7

papillary serous, responds wel to carboplatin