ovarian cancer

Question 1

the risk factors for ovarian CA are hormonal in nature. the risk is greater if what is not suppressed?

Answer 1

ovulation

Question 2

what are the risk factors for ovarian CA?

Answer 2

many ovulations:

• early menarche
• late menopause
• nulliparity

fam hx:
- BRCA1 / BRCA2 gene mutations

others: HRT, obesity

Question 3

why does ovarian CA carry a poor Px?

Answer 3

late Dx

80% of women have advanced disease at presentation

46% 5 y.s.

Question 4

what are the clinical features of ovarian CA?

Answer 4

1. abdo distension and bloating
2. abdo + pelvic pain
3. urinary sx e.g. urgency
4. early satiety
5. diarrhoea

Question 5

what are the Ix for ovarian CA?

Answer 5

1. CA125

2. USS

Question 6

what other conditions may raise CA125 level?

Answer 6

endometriosis, menstruation, benign ovarian cysts

CA125 should not be used for screening for ovarian CA in asx women

Question 7

what should be done if CA125 is raised (≥35 IU/mL)?

Answer 7

urgent USS of abdo and pelvis

Question 8

what does Dx of ovarian CA involve?

Answer 8

Dx is difficult and usually involves Dx-tic laparotomy

Question 9

what reduces the risk of ovarian CA (a.k.a. protective factors)?

Answer 9

• COCP (fever ovulations)

- many pregnancies (suppresses ovulation)

Question 10

RMI (risk malignancy index) is the pre-surgical prognostic criteria recommended by NICE. what are the 3 components of the RMI?

Answer 10

CA125
menopausal status
US findings

Question 11

how does ovarian CA spread initially?

Answer 11

local spread within the pelvic region

Question 12

how are stage 2-4 ovarian CA treated?

Answer 12

surgical excision of the tumour +/- chemo