Ovarian Cancer Flashcards
Ovarian Cancer
Etiology
Etiology
- second most common GYN cancer
- highest cause of death: detected so late since symptoms are so vague
- incidence: cancer associated with 60 yera olds
How does it happen
- unknown
- central adiposity & increased wasit-hip ratio: because increase androgens and increase CA risk
- industiralized countries
Risk
- higehst risk in family history first degree relative or having a cancer syndrome
Theories
- increase ovulation could increase risk
- possible probelem with tissu repair after ovulation could disrupt normal cells and increased risk
Ovarian Cancer
Risk factors
Risk Factors
- age: caner of the 60s
- infertility (protective things like being prenant or on OCPs long term or Breastfeeding)
- obestiy
- history of using danazol an androgen for endometriosis
- family history of ovarian or colon cancer!!! 1st or 2nd degree relative almost 12x risk
refer for genetic testing for BRCA 1 and 2
Screening? what if you have known family history
Screening??
TVUS: can be used; NOT recommende dthough, as it wont tell you if the mass is benign or maligant
TVUS + CA-125: can be use in those BRCA 1 + 30-35 OR BRCA 2 + 35-40 5-10 yeras before their realtive age of diagnosis
prophylatic ophroetcomy consider in those wiht 1st degree family realtive and done having children
What is CA-125 & role with ovarina cancer
CA-125 = cancer marker: expressed by 80% of the ovarian epitheial cancer cells
not specific but can be good in the right clincial picture
a level > 35 is considered elevated … but can be due to…
- endometiral
- tubal
- lung
- breast
- pancreas
- ovary
also can be eleavted in bening conditions
- PID, fiberoids, endometrisois, liver disease and hemorraghiv ovarian cysts
can be considered helpful in a postmenopausal women with an ovarian mass: as they shoudl be getting cysts!!
premenopausal: check other markers not this
Symptoms and Signs of Ovarian Cancer
Symptoms
- unexpected chagnes in bowel/bladder habits: constipation, urianry frequency or incontinence
- GI upset: gas, indigestion, nasuea, bloating
- unexplained weight loss/gain
- pelvic pain, bloating, swelling
- fullness feeling
- fatigue
- pain during intercourse
the symptoms usually indicate where the Met has gone: bladder or bowel for example
early on = asymptomatic
- blaoting, nasuea, lower abd. pain
later: ascites, bowel obstruction and unriary signs
Diagnsois of Ovarian Cancer
Ovarian Mass
- seen on pelvic exam: shouldnt feel the ovaries but if felt on bimanual: sus
- any enlargement over 5 cm is considered abnormal
TVUS: best screening methods to see the mass
MRI: used to see how solid the mass is
anything solid near or on ovary: needs to be removed
cystic lesion? consider age, OCP, etc. to see risk
- cyst in post-menopausl: highly sus
Evaulation of a Mass
Simple cyst: watch; if getting to 8-10 cm, remove
complex cyst: watch at any size, recheck with TVUS to see if it goes away
any cyst post-menopause = sus
Ovarian Cancer: types of tumors depending of tissue it is ariseing from
Ovarian Anatomy : 3 types of tumors
Epithelial tumors: from the outer surface of the ovary
85-90% of cancer is from here
Germ Cell Tumor: from the cells that make the ova
Stromal tumors: from teh structural cells which make up the ovary and produce the estrogen
Ovarian Cancer
Diagnosis and Staging
Diagnosis
- established via histological exam of the tumor tissue that is removed surgical after finding on TVUS and exam
preop: a CT, CA-125 and colonospcy, etc. can be done to determine if it has mets and to wear
(may need to bowel prep before surgeyr in case colonscopy is warrented during)
Staging
Stage 1: limited to ovary only
stage 2: limiteid to ovar: peliv extension
stage 3: peritoneal impalnts outside the pelivis
satge 4: distant mets
usualyl found late
Ovarian Cancer
Management
Management
early stages: TAH with SBO and lymph/omentecomty
surgical debulking: remove as much tumor as possible
- for stage 3-4
mutipe chemo agents used
falling CA-125 after: shows good signs
second look lap: done 1-2 years later : usually 50% find more
Prognosis
- for invasive epithelial (MC) : 50% survival
- for stromal: 89%
- for germ: 92%
- fallopian: 55%
