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Reproductive > Clinical Pathology Ovary > Flashcards

Clinical Pathology Ovary Flashcards

1
Q

Epidemiology of ovarian cancer?

A
  • 600 cases per year in Scotland
  • 400 deaths per year in Sco
  • 5 year survival all cases 30%
  • Most present with advanced cases
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2
Q

What age is it rare to get ovarian cancer?

A

<30

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3
Q

Which genes predispose people to ovarian cancer? What are features of people who present with genetic predisposed ovarian cancer?

A
  • HNPCC/Lynch type II familial cancer syndrome
  • BRCA1
  • BRCA2

Likely to present earlier and have good prognosis

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4
Q

What is the reason most women present with advanced stage?

A

The symptoms of ovarian cancer are VAGUE

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5
Q

What are some of the symptoms of ovarian cancer?

A
  • Indigestion/early satiety/poor appetite
  • Altered bowel habit/pain
  • Bloating/discomfort/weight gain
  • Pelvic mass: however the mass can grow to quite a size without the patient knowing
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6
Q

How is diagnosis normally made for ovarian cancer?

A
  • Clinical signs are normally vague so,
  • USS normally carried out and if suspect then,
  • CT scan: however this is not diagnostic (raises suspicion) and diagnosis is usually carried out pathologically post resection
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7
Q

What is CA 125? How useful is this marker? Normal range?

A
  • Marker used to detect ovarian cancer + breast cancer + colon/pancreatic
  • While it is often elevated in ovarian cancer there are many other reasons it is elevated in pre menopausal women
  • Therefore not that accurate a marker
  • 0 - 30 is normal range
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8
Q

What are the accuracy rates of CA 125?

A
  • 80% of women with ovarian cancer have a raised CA 125
  • 50% of women with stage 1 disease
  • Used in detecting and monitoring epithelial ovarian tumours
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9
Q

What is the RMI and how do we calculate it?

A

Risk of malignany index

RMI = U (ultrasound) x M (menopausal status) x CA 125

USS features:

  • Multi locular
  • Solid areas
  • bilateral
  • ascites
  • intra abdominal
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10
Q

How is ovarian cancer staged?

A

Staging

  1. Limited to ovaries with capsule intact/ cytology
  2. One or both ovaries with pelvic extension
  3. One or both ovaries with peritoneal implants outside pelvis or + nodes
  4. Distant metastases
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11
Q

Which nodes does ovarian cancer normally spread to?

A

Para-aortic nodes

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12
Q

What is the treatment of ovarian cancer?

A
  • Gold standard: Surgical resection and the adjuvant chemotherapy
  • There has been talk of flipping this round but this is current way, such as neo-adjuvant chemo
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13
Q

What is the surgery undertaken? And roles of the surgery?

A

Laparotomy

  • Midline incision
  • Obtain tissue diagnosis
  • Stage disease
  • Disease clearance
  • Debulk disease (try reduce to 1cm)
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14
Q

What is the first line chemo? When administered?

A
  • Platinum and taxane (Taxol)
  • Within 8 weeks post surgery
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15
Q

What are the cure rates for each stage?

A
  1. [stage] 85%
  2. [stage] 47%
  3. [stage] 15%
  4. [stage] 10%
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16
Q

Which stage is likely to recurre and what is the treatment?

A
  • Stage 4 is most likely to recurre.
  • Chemo
  • Palliation: symptomatic recurrance
  • Platinum if > 6mths
  • ?surgery
  • Tamoxifen
17
Q

What are the features of benign ovarian cysts?

A
  • More common than malignant ones
  • Will have a smooth surface over a defined area
  • Serous cysts
18
Q

What is an intermediate between benign and malignant ovarian cysts?

A

Borderline ovarian cysts: they can be mucinous or serous

19
Q

Where do most ovarian cancers arrise?

A
  • Fallopian tube
  • Often will be able to see changes in epithelium of fallopian tube that is pre cancerous
20
Q

What is important to note about BRCA?

A
  • Inheritted in autosomal dominant fashion
  • Need to think about offspring and sisters and other fam members.
  • 15-45% risk if you carry this gene of lifetime risk of ovarian cancer – these ladies tend to develop them earlier stage
21
Q

What are the current guidelines on ovarian cancer screening?

A
  • Population screening is not proven
  • High risk women: cancer gene mutation carriers, 2 or more relatives
  • Carry out a pelvic examination
  • US scan of ovaries
  • CA 125
22
Q

What are the downsides of ovarian cancer screening?

A
  • Not recommended
  • Limited sensitivity and specificity
  • FIGO stages of cancer detected
  • For high risk women
    • Prophylactic oophorectomy
  • Residual risk of primary peritoneal cancer

Reproductive (34 decks)

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