5 - Gynae - The Ovary and its disorders - Ovarian Cancer Flashcards Preview

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Flashcards in 5 - Gynae - The Ovary and its disorders - Ovarian Cancer Deck (15):
1

silent and presx late giving 5y survival ??
rates incr with? >80% cases in women ?, when is highest incidence? what reduces risk?

<35%
age - >50 (postmenopausal)
80-85
taking COCP

2

Pathology - 90% are ? carcinomas. Grade of mal vaies from ? to ?
what is rare but most common in <30s?
most common type?

epithelial carcinomas
borderline to high
germ cell tumours
serous cystadenocarcinoma

3

aetiology - benign cysts can have ? ? RFs relate to ? of ? - therefore early ? and late ? and ? are RF's , and what 3 things are protective?
ov ca may also be familial - gene muts implicated? what gives risk of 50%?

mal change
no of ovulations
menarche and late menopause and nulliparity

pill, preg, lactation

BRCA1+2 and HNPCC
BRCA1

4

Screening - what is done? those w genetic muts offered ?? and ? screening, or prophylactic ?

nothing atm - trials ongoing
yearly TVUSS and CA125 screening
prophylx (B)SO

5

Clinical features - Hx
-Sx often initially ?/?
-70% presx with stage ?/? disease
-5 symptoms ?

vague/absent
3-4
bloating, feel full/lost appetite/wt loss, change in bowel habit, pelvic/abdo pain, incr urgency +/ freq

6

Many Sx are similar to ?, but must exclude ov ca in ? ?

Ask about ? and ? Sx as it may be ? from these sites

Ex - 3 things to look for? v large masses are likely to be ? , what not to forget?

IBS
older women

Breast and GI as it be mets from these sites

cachexia, abdo/pelvic pain, ascites
malignant
palpate breasts also

7

Signs that ovarian mass is malignant? 6 things

rapid growth, >5cm
ascites
advanced age
bilat masses
solid or septate nature on USS
incr vascularity

8

Staging - give general outline of 4 stages

1 - macroscopically confined to the ovaries
2 - beyond ovaries but confined to pelvis
3 - beyond pelvis but confined to abdomen (freq omentum, S Bowel, peritoneum)
4 - beyond abdomen eg lungs/liver parenchyma

9

Ix - initial detection 1' care - ? measured in >50 with what? if raised (>?) what is done? what prompts urgent ref to 2' care?

CA125 measured in women >50 with abo Sx
>35 -> USS abdo+pelvis done
urgent ref if USS/Ex finds ascites/mass

10

Ix - establishing diagnosis 2' care.
what done if not done already? what is measured if <40 and why?

what is then calculated? and how/with what? what values are you worried about? who gets ref to MDT?

how is cancer extent assessed? and further staging done?

CA125 and USS
hCG and AFP - raised in germ cell tumours and not epithelial ov ca

RMI - risk of mal index -
RMI = U (USS score) x M (menopause score) x serum CA125

>200
>250 -> specialised MDT

CT of pelvis and abdo for extent and surgery to further stage

11

MGMT - two key things?
- when is RTx used?

assess fitness for surgery
cross match blood

only for dysgerminomas

12

Surgical mgmt

? ? allows thorough assessment. total ? with ? and partial ? done, with ? of any peritoneal deposits, random ? biopsies and ? ? assessment.
If suspect stage 1 - retroperitoneal LNs are ?, in stage 2 or more they are all ? by ? ?
if ?/?? and disease is borderline, ? and unaffected ovary may be left but need ?

abdo laparotomy
hyst with BSO and partial omentectomy
biopsies
peritoneal biopsies
retroperitoneal LN
sampled
removed by block dissection
young/presering fertility
uterus
follow up

13

Chemotherapy.

? ? ? req before CTx. If surgery not done tissue for ? obtained through ? ? ? ? or laparoscopy. ? levels used to monitor CTx response. 2/3ths of women who respond to 1st line chemo relapse within ?
when is chemo not usually given?

confirmed tissue diagnosis
histo
percutaneous image guided biopsy
CA125
2ys
v early on (low grade histo stage 1a/b)

14

F/U.

CA125 levels useful during and after ?
? aids detection of ?/?
interval ? of residual tissue
CTx prolongs ? ? ? and improves ???

CTx
CT residual disease/relapse
debulking
short term survival and improves QOL

15

Prog.
overall 5y survival?
why?
what is death normally from?
poor prog indicators? (4)

<35% - presx at late stage
bowel obstruction/perf
advanced stage, poor diff, clear cell tumours, slow/poor response to chemo

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