Ovarian Cancer

Question 1

Why is it that ovarian cancer typically presents late?

Answer 1

It has very non-specific symptoms

Question 2

What are the three types of ovarian tumours?

Answer 2

1. epithelial cell tumours
2. Germ cell tumours
3. Sex cord stromal tumours

Question 3

What is the most common type of ovarian tumour?

Answer 3

Epithelial cell tumours

Question 4

What are the 5 subtypes of epithelial ovarian cancer?

Answer 4

1. Serous tumours
2. Endometrial tumours
3. Clear cell tumours
4. Mucinous tumours
5. Undifferentiated tumours

Question 5

Are ovarian germ cell tumours benign or malignant?

Answer 5

Benign

Question 6

What is another name given to ovarian germ cell tumours?

Answer 6

Dermoid tumours / Teratoma

Question 7

Describe the composition of ovarian germ cell tumours:

Answer 7

teratomas contain various tissue types such as skin, teeth, hair and bone

Question 8

What two blood markers are ovarian germ cell tumours associated with?

Answer 8

1) alpha fetoprotein
2) human gonadotropin (hCG)

Question 9

Are sex cord stromal tumours benign or malignant?

Answer 9

either

Question 10

What are sex cord stromal tumours?

Answer 10

rare ovarian tumours that arise from connective tissue or sex cords

Question 11

What are sex cords?

Answer 11

embryonic structures associated with follicles

Question 12

Give two examples of sex cord stromal tumour subtypes:

Answer 12

1) Sertoli-Leydig cell tumours
2) granulosa cell tumours

Question 13

What percent of ovarian tumours are epithelial?

Answer 13

85-90%

Question 14

What percent of ovarian cancer are germ cell tumours?

Answer 14

5-7%

Question 15

What percent of ovarian cancers are Sex-cord stromal?

Answer 15

5-7%

Question 16

What is the breakdown of the epidemiology of epithelial tumours?

Answer 16

Serous – most common – about 50% of cases
Endometroid – 20%
Clear cell tumours – 6%
Mucinous – 10%
Brenner – rare
Undifferentiated

Question 17

What are hormone factors that increase the risk of epithelial ovarian cancer?

Answer 17

1. increased risk with low fertility
2. Early menarche
3. LAte menopause
4. Use of HRT

Question 18

What are lifestyle factors that increase the risk of epithelial ovarian cancer?

Answer 18

1. Obesity
2. Smoking
3. Lack of exercise
4. Talc powder used pre 1975
5. Exposure to asbestos

Question 19

What are previous medical history factors that increase the risk of epithelial ovarian cancer?

Answer 19

1. pelvic inflammatory disease
2. cancer of breast or bowel
3. Increasing age
4. endometriosis

Question 20

What are genetic factors that increase the risk of epithelial ovarian cancer?

Answer 20

1. Family history
2. BRCA1, BRCA 2, HPNCC

Question 21

What is a protective factor against ovarian cancer?

Answer 21

1. Use of oestrogen containing contraceptives

Question 22

What are some symptoms of ovarian cancer?

Answer 22

1. Vague abdominal distention
2. Urinary frequency
3. Dysuria
4. Fever
5. Weight Loss
6. Pelvic mass
7. Acites
8. Abnormal uterine bleeding
9. Rupture/local peritonism

Question 23

What is the name given to secondary tumours in the ovary?

Answer 23

Krukenberg tumours

Question 24

Which primary tumours commonly give rise to ovarian cancer?

Answer 24

GI cancer (stomach)

Question 25

What is the characteristic sign of a Krukenberg tumour on histology?

Answer 25

Signet ring

Question 26

Give 6 risk factors for ovarian cancer:

Answer 26

1) age (peak incidence at 60) 2) BRCA1 and BRCA2 3) increased number of ovulation 4) obesity 5) smoking 6) repeat use of clomifene (infertility treatment)

Question 27

Give 3 ovarian cancer red flag symptoms that warrant an immediate 2WW referral:

Answer 27

1) ascites 2) pelvic mass 3) abdominal mass

Question 28

Give 6 symptoms that indicate the need for a CA125 blood test:

Answer 28

1) new symptoms of IBS 2) bloating 3) early satiety 4) pelvic pain 5) urinary frequency and urgency 6) weight loss

Question 29

CA125 is not specific to ovarian cancer - give 6 other conditions where it may be raised:

Answer 29

1) fibroids 2) endometriosis 3) adenomyosis 4) pelvic infection 5) liver disease 6) pregnancy

Question 30

What criteria is used to estimate risk of ovarian cancer?

Answer 30

Risk of Malignancy Index

Question 31

What three factors does the Risk of Malignancy Index take into account when assessing risk of ovarian cancer?

Answer 31

1) menopausal status 2) ultrasound findings 3) CA125 level

Question 32

In what instance would alpha-fetoprotein and HCG testing be indicated in the context of ovarian cancer?

Answer 32

if the patient is under 40 with a complex ovarian mass (this points towards a germ cell tumour which would produce alpha-FP and HCG)

Question 33

What is the name of the ovarian cancer staging system?

Answer 33

FIGO staging

Question 34

Summarise FIGO staging for ovarian cancer:

Answer 34

1) stage 1 - confined to the ovary 2) stage 2 - spread outside of ovary but inside pelvis 3) stage 3 - spread outside pelvis but inside abdomen 4) stage 4 - spread outside of the abdomen (distant metastases)

Question 35

What is the typically treatment plan for ovarian cancer?

Answer 35

a combination of surgery and chemotherapy

Question 36

what is the epidemiology of ovarian cancer?

Answer 36

60yrs

Question 37

what is the prognosis of ovarian cancer?

Answer 37

poor - usually advanced disease at presentation