Workshop - CPC of ovary Flashcards
Epidemiology of ovarian cancer in scotland
600 cases a year and 400 deaths
5YS - 30%
Risk factors and protective factors for ovarian cancer
rare under 30, OCP, pregnancy and breast feeding protective
high risk families are 5-10% of all cases eg HNPCC/BRCA1/BRCA2, incessant ovulation
Symptoms of ovarian cancer
VAGUE! pelvic mass bloating/distension/weight gain indigestion/early satiety/poor appetite altered bowel habit/pain
Diagnosis of ovarian cancer
surgical/pathological
CA 125
USS of abdomen and pelvis
CT scan to stage
What is CA125?
glycoprotein antigen that can increase with peritoneal irritation
malignancies which use CA125
breast, colon, pancreas, ovarian epithelial tumours
Benign conditions which use CA125
PID, endometriosis, liver disease, recent surgery, effusions
RMI =
U X M X CA125
RMI stands for
risk of malignancy index
USS findings for RMI
multi-locular, solid areas, bilateral, ascites, intra-abdominal
score for USS in RMI
1=1, 2-5 = 3 points
menopausal status in RMI and the score
pre = 1 post = 3
Staging 1-4 of ovarian cancer
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
gold standard for treating ovarian cancer
surgery
Laparotomy for ovarian cancer aims (4)
obtain tissue diagnosis
stage disease
debulk disease
disease clearance
1st line chemo used
platinum and taxol
Chemo regimen
within 8 weeks of surgery
average response is 2 years
unlikely to cure in stage 3 and 4
Cure rates for stage 1-4
1 - 85%
2 - 47%
3 - 15%
4 - 10%
Recurrence of ovarian cancer
platinum if more than 6 months
?surgery
palliation
tamoxifen
Ovarian cancer screening
not proven
high risk women - USS, pelvic exam and CA 125
Women at high risk should be offered what?
prophylactic oophorectomy and salpingectomy
Even after prophylactic surgery what are high risk women still at risk of?
primary peritoneal cancer
2 origins of ovarian cancer
pre-existing benign cysts
fallopian tube - fimbral end sheds cells
BRCA genes inheritance
autosomal dominant
% risk of ovarian cancer in BRCA
15-45
Role of BRCA genes
tumour suppression, cell cycle control and DNA repair
