Workshop - CPC of ovary

Question 1

Epidemiology of ovarian cancer in scotland

Answer 1

600 cases a year and 400 deaths

5YS - 30%

Question 2

Risk factors and protective factors for ovarian cancer

Answer 2

rare under 30, OCP, pregnancy and breast feeding protective

high risk families are 5-10% of all cases eg HNPCC/BRCA1/BRCA2, incessant ovulation

Question 3

Symptoms of ovarian cancer

Answer 3

VAGUE!
pelvic mass 
bloating/distension/weight gain 
indigestion/early satiety/poor appetite
altered bowel habit/pain

Question 4

Diagnosis of ovarian cancer

Answer 4

surgical/pathological
CA 125
USS of abdomen and pelvis
CT scan to stage

Question 5

What is CA125?

Answer 5

glycoprotein antigen that can increase with peritoneal irritation

Question 6

malignancies which use CA125

Answer 6

breast, colon, pancreas, ovarian epithelial tumours

Question 7

Benign conditions which use CA125

Answer 7

PID, endometriosis, liver disease, recent surgery, effusions

Question 8

RMI =

Answer 8

U X M X CA125

Question 9

RMI stands for

Answer 9

risk of malignancy index

Question 10

USS findings for RMI

Answer 10

multi-locular, solid areas, bilateral, ascites, intra-abdominal

Question 11

score for USS in RMI

Answer 11

1=1, 2-5 = 3 points

Question 12

menopausal status in RMI and the score

Answer 12

pre = 1 
post = 3

Question 13

Staging 1-4 of ovarian cancer

Answer 13

1 - limited to ovaries and capsule intact
2 - 1 or both ovaries with pelvic extension
3 - 1 or both ovaries and peritoneum outside pelvis or + LN
4 - mets

Question 14

gold standard for treating ovarian cancer

Answer 14

surgery

Question 15

Laparotomy for ovarian cancer aims (4)

Answer 15

obtain tissue diagnosis
stage disease
debulk disease
disease clearance

Question 16

1st line chemo used

Answer 16

platinum and taxol

Question 17

Chemo regimen

Answer 17

within 8 weeks of surgery
average response is 2 years
unlikely to cure in stage 3 and 4

Question 18

Cure rates for stage 1-4

Answer 18

1 - 85%
2 - 47%
3 - 15%
4 - 10%

Question 19

Recurrence of ovarian cancer

Answer 19

platinum if more than 6 months
?surgery
palliation
tamoxifen

Question 20

Ovarian cancer screening

Answer 20

not proven

high risk women - USS, pelvic exam and CA 125

Question 21

Women at high risk should be offered what?

Answer 21

prophylactic oophorectomy and salpingectomy

Question 22

Even after prophylactic surgery what are high risk women still at risk of?

Answer 22

primary peritoneal cancer

Question 23

2 origins of ovarian cancer

Answer 23

pre-existing benign cysts

fallopian tube - fimbral end sheds cells

Question 24

BRCA genes inheritance

Answer 24

autosomal dominant

Question 25

% risk of ovarian cancer in BRCA

Answer 25

15-45

Question 26

Role of BRCA genes

Answer 26

tumour suppression, cell cycle control and DNA repair