Treatment of ovarian cancer (MF) Flashcards
age for ovarian cancer
risk factors
FH
genetics
> 50
nulliparity (or low parity), delayed pregnancy
FH of breast or ovarian cancer
BRAC1 (40%) and BRAC2 (18%)
when does ovarian cancer present
usually late - 60% late stage at diagnosis
how does ovarian cancer present
ascites/bloating
pelvic mass/bladder dysfunction
pleural effusion/SOB
incidental finding
which women should be offered BRAC1 and BRAC2 mutation testing
non mucinous ovarian or fallopian tube cancer
which women should have a genetic risk assessment
women with ovarian tumour who have a family history of breast, ovarian or colon cancer
ovarian cancer diagnosis
CA125 - can be raised in other conditions
US - transsvaginal/abdominal
cytology - pleural fluid/ascites
pathology - usually gold standard
US features
multilodular cyst solid areas bilateral lesions ascites intra abd mets
0=none
1=1
3=2 or more
score given for menopausal
pre 1
post 3
RMI score
when should be referred
US X menopausal score X CA123 U/ml
If over 200
FIGO 1 2 3 4
1 = confined to 1 or both ovaries
2=spread to other pelvic organs
3=spread beyond pelvis within the abdomen
4=spread into other organs eg. liver, lungs
prognosis of ovarian cancer 5 yr survival
1 80-90%
2 65%
3 15-35%
4 up to 15%
the three types of ovarian cancer spread
transcoelemic spread/peritoneal seeding within pelvis -> abd cavity
heat -> liver, lungs, brain (late and rare)
incident of brain mets in ovarian cancer is <2%
pathology of ovarian cancer
> 90% epithelial cell tumours of ovary - serous, mucinous, endometriod, clear cell, undifferentiated
<10% germ cell, granulosa cell
ovarian cancer treatment
surgery - TAH, BSO, omentectomy, optimal bulking
surgery and chemo
chemo and surgery
timing and sequence
ovarian cancer chemo response rate
relapses?
palliative chemo?
response rates of 60-70% with carboplatin/paclitaxel
relapse rates are high
palliative - carboplantin, pac, etoposide, calyx, topotecan, gemcitabine, chlorambucil
