Ovarian Carcinoma

Question 1

OUTLINE THE CLASSIFICATION OF OVARIAN TUMOURS (3 most important types of ovarian tumours)

Answer 1

Primary Ovarian Tumours

1. Epithelial tumours
   -about 90% of ovarian tumours are epithelial types
   -tumour originates from surface epithelium tissue of the ovary
   -common in older post menopausal
   -90% chances of survival if detected early stage, majority 75-80% are dx at stages 2 to4
   -ie serous, endometroid, transitional & undifferentiated subtypes
2. Germ Cell Tumours
   -About 5% of ovarian cancers
   -originate from primordial germ cells of the ovary
   -common in young people under 30
   - Ie dysgerminomas, yolk sac or endodermal sinus tumours, embryonal carcinomas & non-gestational choriocarcinomas of the ovary.
   -germ cell carcinomas often contain more than one histological type
3. Sex Cord Stromal Tumours
   -8% of ovarian tumours
   -affects all age groups
   -originate from stromal connective tissue of the ovary
   -many produce hormones eg oestrogen, inhibit, progesterone and testosterone
   -common types: sertoli leydig cell tumours, adult granulosa cell tumours, juvenile granulosa cell tumours
   -May present with virilisation

Question 2

List some of the risk factors for ovarian cancer (4)

Answer 2

Family history
Uninterrupted ovulation
Low parity
Increasing age
Diet
Smoking ?

Question 3

List some of the symptoms of ovarian cancer (4/5)

Answer 3

PMB
Pelvic pain
Weight loss
Vague:Change in bowel habits
Abdominal distension and fullness after meals

Question 4

Give a list of investigations you would do for a pt you suspect has overran cancer

Answer 4

Hb
Preg test in younger
Pap smear
Endometrial sampling (hysteroscopy?)

Metastatic screen
UEC, LFTs
X-RAY
CT of abdomen and Pelvis
Mammogram
Tumour markers: CA 125, AFP, LDH, bHCG

Question 5

Outline the staging of ovarian cancer (4)

Answer 5

Stage 1: tumour confined to one or both ovaries
Stage 2: involves one or both ovaries and extends to other pelvic organs
Stage 3: tumours has extended to adjacent structures ie bowel lining, abdominal peritoneum or lymph nodes
Stage 4: tumour metastasised to distant organs eg liver or chest

Question 6

Descuss the management of ovarian cancer

Answer 6

Surgery is good standard
-TAH(total abdominal hysterectomy)
-BSO (bilateral salpingo-oophorectomy)
-Omentectomy (thin fold of tissue encasing the abdo organs ei intestines&stomach and contains lymph nodes and vessels)

Question 7

What is the management of germ cell tumours (1)

Answer 7

Multiple Agent Chemotherapy

Question 8

What is the management of sex cord stromal tumours (1)

Answer 8

Surgical