Ovarian Cancer

Question 1

Why does this have the worst prognosis of all the gynae cancers?

What is its most common type?
→ What are the other types?

Answer 1

➊ Often presents late – >70% present after it has spread beyond the pelvis

➋ Epithelial cell tumours
→ • Germ cell tumours/ Dermoid cysts – Benign – can contain skin, teeth, hair and bone
• Sex cord-stromal tumours

Question 2

What are its risk factors?

What are its protective factors?

Answer 2

➊ • Older age
• BRCA1/2 +ve
• Increased number of ovulations – Early menarche, Late menopause, Nulliparity
• Obesity
• Smoking
• HRT

➋ • Pregnancy
• Breastfeeding
• COCP

Question 3

How does it present?

Answer 3

• Symptoms develop late and are often non-specific
• Bloating
• Early satiety/Loss or appetite
• Pelvic pain
• Urinary symptoms (urgency/frequency)
• Hip/Groin pain – Ovarian mass can press on Obturator nerve lateral to it

Question 4

Which investigations should be done?

How is it managed?

Answer 4

➊ CA125 – If >35 IU/ml, do a Pelvic US

➋ • Urgently refer any woman with ascites and/or an unexplained pelvic/abdominal mass
• Surgery +/- Chemotherapy