Gynae cancers Flashcards
(29 cards)
What is the effect of COCP on ovarian cancer?
Protective/reduce the risk
What is the mean age of diagnosis of ovarian cancer
63
What are 6 risk factors of ovarian cancer?
- FH - BRCA 1 + 2, HPNCC
- Early menarche
- Late menopause
- Nulliparity
- Smoking/obeisity
- Unopposed oestrogen use/other oestrogen modulators eg. Tamoxifen
What are the protective factors against ovarian cancer?(3)
- pregnancy
- Lactation
- Tubal ligation
Is there a screening programme for ovarian cancer?
NO - presents late
What do you offer high risk women for ovarian cancer?
Prophylactic sapling-oophrectomy
Clinical features of ovarian cancer (6)
- Non specific symptoms, usually present in later stages
- Abdominal bloating/distension or mass pain
- Loss of appetite
- Pelvic pain
- Increased urinary frequency and urgency
- Breast and GI symptoms
- Weight Loss
What signs do you see on examination of ovarian cancer? (4)
- Cachexia
- Abdominal/pelvic mass
- Ascites
- Breast examination
How does ovarian cancer spread? (3)
- Direct in the pelvis and abdominal transcoelomic spread
2. Lymphatic and rarely blood borne
What is the most common cellular type of ovarian cancer?
- 95% are epithelial cell carcinomas of which 75% are serous, 10% are clear cell and 10% are endomatrioid and 10
What are the Stages of ovarian cancer?
Stage 1: macroscopically confined in ovaries
Stage 1a: one ovary is affected with an intact capsule
Stage 1b: both ovaries are affected with an intact capsule
Stage 1c: 1a/b with tumour on the surface, ruptured capsule, cytologically positive ascites or positive peritoneal washings
Stage 2: disease extending into the pelvis/uterus/fallopian tubes
Stage 3: abnormal disease/affected lymph nodes
Stage 4: disease is beyond the abdomen eg. Lung or liver parynchyma
List 6 features of malignant ovarian cancer
- Rapid growth >5 cm
- Ascites
- Advanced age
- Bilateral masses
- Solid or septate nature on ultrasound scan
- Increased vascularity
How do you investigate ovarian cancer?
Bloods and CA125 –should be done in women above 50 with abdominal symptoms
If ca125 >35 IU/ml –needs urgent ultrasound pelvis and abdomen
<40years – AFP and HCG to rule out germ cell tumours
RMI (Risk of Malignancy Index)-
RMI >250 are referred to MDT
CT thorax abdopelvis
Further staging performed at surgery
What raises CA125
- Epithelial ovarian cancers
- Endometriosis
- Pregnancy
- PID
- Menstruation
- Other cancers like endometrial/fallopian tube
In which age group are Germ cell tumours common?
<30
How do we stage ovarian cancer?
surgical and histological
What is the management for ovarian cancer?
- Midline laparotomy allows through assessment of pelvis/abdomen - staging
- Peritoneal washings for cytology
- TAH( Total Abdominal Hysterectomy)/BSO( Bilateral Salpingo oophorectomy)/Partial omentectomy With biopsies of peritoneal deposits
- Lymph node dissection if indicated
When is Chemotherapy used in ovarian cancer?
- Stage 1a and Ib- not given
- Stage 1c- 6 cycles of carboplatin are given
- Stage 2 -4- carboplatin plus paclitaxel
How do you treat Dysgerminomas?
Radiotherapy
How do you treat borderline ovarian tumours?
preserve fertility by removing affected ovary and tube and meticulous follow up
How do you follow up a patient with ovarian cancer?
- CA-125
2. CT scan to detect relapse
What are poor prognostic signs of ovarian cancer?
- Advanced stage
- Poor cell differentiation
- Clear cell tumours
- Slow response to chemotherapy/radiotherapy
How do you manage a patient with ovarian caner palliatively?
- Pain- analgesic ladder
NSAIDS-low dose Codeine-high dose codeine-morphine - Nausea and vomiting-antiemetics – anticholinergics/antihistaminic/ondansetron
- Heavy vaginal bleeding –high dose progesterone/radiotherapy
- Ascites may have to be drained
- Intestinal obstruction- stool softeners/enemas/cyclizine/ondansetron
Which lymph node does ovarian cancer metastasise to?
Pelvic and Para-aortic
Inguinal
