Ovarian cancer

Question 1

what is the 5yr survival for all stages?

Answer 1

30%

Question 2

what poses a high risk genetically?

Answer 2

HNPCC,Lynch type 2 familial cancer, BRCA1, BRCA2

Question 3

what is protective?

Answer 3

OCP

Question 4

sy/sx

Answer 4

Can be very vague, Indigestion/poor appetite, Altered bowel habit/pain, Bloating/discomfort, Weight gain, Pelvic mass: Asymptomatic, Pressure symptoms = late stage symptoms

Question 5

dx/ix

Answer 5

CA125, uss abdo, uss pelvis, CT scan for staging, Surgical pathological diagnosis

Question 6

what is CA125?

Answer 6

Glycol-protein antigen. Malignancy: Ovary, Colon/pancreas, Breast. Benign conditions: Menstruation/endometriosis/PID, Liver disease/recent surgery/effusions. 80% of women with ovarian cancer have raised CA 125

Question 7

what is RMI and how is it calculated?

Answer 7

(Risk of malignancy index) RMI = U x M x CA 125
• U = ultrasound features
• M = menopausal status
• CA 125 = CA 125 level
• RMI >200 = significant risk of malignancy

Question 8

staging of ovarian cancer (done by CT)

Answer 8

1 - limited to the ovaries with the capsule intact
2 - one or both ovaries with pelvic extension
3 - one or both ovaries with peritoneal implants outside the pelvis or node involvement too
4 - distant mets

Question 9

Tx

Answer 9

Surgery
Laparotomy - Obtain tissue diagnosis, Stage disease, Disease clearance, Debulk disease
Chemotherapy: Adjuvant or neo-adjuvant - First line = platinum and taxane (Taxol), Within 8 weeks of surgery, Complete/partial response, Cure unlikely, Average response = 2 year
Recurrence - Chemotherapy, Palliation – in symptomatic recurrence, Platinum if >6 months, Tamoxifen.

Question 10

Ovarian Cancer screening…

Answer 10

High risk women - Gene mutation carriers, 2 or more relative, Some high risk women have prophylactic oophorectomy, Pelvic examination, US scanning of ovaries, CA 125.
FIGO stages of cancer detected