Ovarian Cancer

Question 1

What genes are implicated in ovarian cancer?

Answer 1

BRCA1
BRCA2
HNPCC type 2

Question 2

What are the BRCA 1&2 gene?

Answer 2

Breast and ovarian cancer gene’s

Question 3

Typical presentation?

Answer 3

” 61 y/o woman presents with 3/12 history of progressive worsening abdominal bloating. She was recently diagnosed with IBS but her symptoms have not improved with diet modifications. O/e her abdomen is distended and slightly tender. Pelvic exam shows the cervix deviated to one side slightly. Bi-manual palpation shows an adnexal mass. “

The IBS diagnosis was incorrect but is a strong DDx for ovarian cancer.

Question 4

How else can ovarian cancer present in emergency?

Answer 4

Ovarian torsion –> acute abdomen

Question 5

Systemic symptoms?

Answer 5

Systemically well

Question 6

What GI symptoms may be present in ovarian cancer?

Answer 6

Lower abdo mass
Dyspepsia
Early satiety –> weight loss
Abdominal distention

Late stage = ascites

Question 7

How might the urinary system be affected by an adnexal mass?

Answer 7

Pressure –> urgency

Question 8

What are risk factors besides BRCA1,2 and HNPCC?

Answer 8

Older
Early menarche
Late menopause
Nulliparity
HRT/OCP

Question 9

Investigations of suspected ovarian cancer?

Answer 9

USS

Bloods

MRI

Question 10

What bloods are most important?

Answer 10

CA125

Question 11

What blood test should be done if <40 y/o?

Answer 11

AFP

Question 12

What scores can be used for ovarian cancer?

Answer 12

RMI

FIGO staging

Question 13

What is the RMI?

Answer 13

Risk of malignancy index
UxMxCA125

USS Findings (1 point for each)

• Ascites
• Mass
• Multinodular cysts
• Mets
• Bilateral

M = menopause

• +3 if yes
• +1 if no

CA125
- Can range form 0-1000s

Question 14

What is the staging of ovarian cancer?

Answer 14

FIGO staging

Question 15

What is FIGO stage one?

Answer 15

Tumour confined to one ovary

Question 16

What is FIGO stage2A?

Answer 16

Tumour has extended to uterus/tubes

Question 17

What is FIGO stage2B?

Answer 17

Extension to other intraperitoneal pelvic organs

Question 18

What is FIGO stage 3A?

Answer 18

Retroperitoneal lymph nodes

Question 19

Stage 3B?

Answer 19

Small mets to extrapelvic organs

Question 20

Stage 3C?

Answer 20

Large mets to extrapelvic organs

Question 21

Stage 4?

Answer 21

Distant mets

Question 22

Order of FIGO staging?

Answer 22

Stage 1 - confined to ovary
Stage 2a - extends to uterus/tubes
Stage 2b - local intraperitoneal organs
Stage 3a - retroperitoneal lymph nodes
Stage 3b - small mets to non pelvic organs
Stage 3c - large mets to non pelvic organs
Stage 4 - distant mets

Question 23

Treatment of stage 1?

Answer 23

Oophorectomy

Question 24

Treatment of stage 2, 3, 4

Answer 24

Chemo

Question 25

What chemo drugs can be used?

Answer 25

Paclitaxel

Cisplatin