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Year 3 - Repro and Anaesthetics > MS Teams Session - Clinical Pathological Conference of the Ovary > Flashcards

MS Teams Session - Clinical Pathological Conference of the Ovary Flashcards

1
Q

what is the epidemiology of ovarian cancer?

A
  • 600 cases per year in Scotland
  • 400 deaths per year in Scotland
  • 23.8 per 100,000 women per year

•5 year survival all stages 40-45%

Most present with advanced disease

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2
Q

who tends to get ovarian cancer?

A
  • Rare < 30 years (often women in their 50s)
  • High risk families 5-10% of cases
  • HNPCC/Lynch type II familial cancer syndrome
  • BRCA1
  • BRCA2

•‘Incessant ovulation’

OCP protective

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3
Q

what are the origins of ovarian cancer?

A
  • Most cases probably actually originate from the fallopian tube
  • Some derive from pre-existing benign ovarian cysts (often low grade cancers)
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4
Q

ovarian cancer can have different origins and what is the pathogenesis for each of them?

A

Green is the most common type of ovarian cancer seen and is the biggest killer of these ladies

Implications of low grade serous carcinoma is very different but can develop into a high grade one, but low grade tend to have longer survival time and don’t respond as well to chemotherapy as not growing rapidly/proliferating as fast

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5
Q

what is the role of pathology?

A

•Type of tumour:

  • Benign
  • Borderline
  • Malignant
  • Tumour grade
  • Tumour stage

All this will help decide prognosis and treatment

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6
Q

what is shown here?

A

Serous cystadenoma

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7
Q

what is shown here?

A

Serous borderline tumour

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8
Q

what is shown here?

A

Serous Carcinoma

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9
Q

what are the symptoms of ovarian cancer?

A
  • Vague! (often missed)
  • Indigestion/early satiety/poor appetite
  • Altered bowel habit/pain
  • Bloating/discomfort/weight gain
  • Pelvic mass:
  • asymptomatic
  • pressure symptoms
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10
Q

how is a diagnosis of ovarian cancer made?

A
  • Surgical/Pathological
  • US Scan abdomen and pelvis
  • CT Scan
  • CA 125 (test measures the amount of the protein CA 125 (cancer antigen 125) in your blood. may be used to monitor certain cancers during and after treatment. may be used to look for early signs of ovarian cancer in people with a very high risk of the disease)
  • Surgery
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11
Q

CA 125 is a marker and a Glyco-protein antigen, what may it be raised in?

A

•Malignancy

  • ovary
  • colon/pancreas
  • breast

•Benign conditions

  • menstruation/endometriosis/PID
  • liver disease/recent surgery/effusions
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12
Q

CA125:

  • 80% of women with ovarian cancer have a raised _________
  • 50% of women with stage _ disease
  • Used in detecting and monitoring __________ ovarian tumours

not __________

A

CA 125

1

epithelial

diagnostic

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13
Q

what is risk of malignancy index?

A

RMI=U x M x CA 125

•Ultra sound features

  • multi-locular
  • solid areas
  • bilateral
  • ascites
  • intra-abdominal
  • Menopausal status
  • CA 125 level
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14
Q

what are the different stages of ovarian cancer?

A
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15
Q

how is the treatment of ovarian cancer done?

A
  • Surgery
  • Chemotherapy
  • Adjuvant
  • Neo-adjuvant
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16
Q

what are the function of a laparotomy

A
  • Obtain tissue diagnosis
  • Stage disease
  • Disease clearance
  • Debulk disease
17
Q

how is chemotherapy used in ovarian cancer and what is its effects?

A
  • First line Platinum and taxane (Taxol)
  • Within 8 weeks of surgery
  • Complete/partial response
  • Cure unlikely
  • Average response 2 years
18
Q

what are the cure rates by stage in ovarian cancer?

A

1 85%

2 47%

3 15%

4 10%

Much more reduced in your advanced stage and this if often how women present

19
Q

how is recurrence delt with?

A
  • Chemotherapy (unlikely a seocnd line chemo with be currative so oftne pallative)
  • Palliation - symptomatic recurrence
  • Platinum if > 6months
  • ?Surgery
  • Tamoxifen (hormonal treatment)
20
Q

Patient EL:

  • 66 year old Para 1
  • Presented with 6 month history of abdominal discomfort, early satiety and constipation
  • Ca125 2560 (normal is 46)
  • CT: extensive ascites, omental cake and peritoneal disease, bilateral ovarian masses

what is done next?

A
  • Ascitic fluid drained
  • US guided biopsy of omentum
  • MDT discussion
21
Q

what is the diagnosis?

A

Diagnosis: High grade serous carcinoma

When positive for WT-1 antibody 90% sure we have a serous carcinoma

Omentum involved so at least a stage 3

22
Q

Pathological diangosis -

Tumour type: High grade serous carcinoma of ovary

Tumour stage: Omental involvement = FIGO Stage III disease (cure rate 15%)

what treamtent can be given to the women?

A
  • Upfront chemotherapy
  • Interval surgery
  • Recurrent disease at 18 months
  • Had 2nd line chemotherapy
  • Further disease progression 9 months later
23
Q

how is ovairan cancer screening done?

A
  • Population screening not proven
  • High risk women - cancer gene mutation carriers, 2 or more relatives
  • Pelvic examination
  • US scanning of ovaries
  • CA 125
  • Not recommended
  • Limited sensitivity and specificity
  • FIGO stages of cancer detected
  • For high risk women - Prophylactic salpingo-oophrectomy
  • Residual risk of primary peritoneal cancer
24
Q

what is the protector trial?

A
  • Preventing ovarian cancer through early excision of tubes and late ovarian removal (PROTECTOR) study
  • Women identified with one of the ovarian cancer genes like BRCA1, BRCA2, or strong family history
  • Standard : ‘risk reducing salpingo oophorectomy’ or RRSO
  • It’s now well established that a large proportion of ovarian cancers start in the fallopian tube
  • This study aims to assess the impact on women of a new two-step option to prevent ovarian cancer
  • Women who enter the study will be offered three options for treatment:
  • Risk reducing early salpingectomy and delayed oophorectomy
  • Standard surgery (oophorectomy and salpingectomy at same time)
  • No operation

•Both operations are usually carried out by keyhole surgery (laparoscopy) under general anaesthesia.

25
Q

Ovarian cancer: what are the main points

A
  • Vague symptoms
  • Often presents with stage 3 or 4 disease
  • Imaging and CA125 = RMI
  • Surgery to stage and to reduce disease bulk
  • Chemotherapy
  • Poor prognosis

Year 3 - Repro and Anaesthetics (50 decks)

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