Ovarian cancer Flashcards
Why is ovarian cancer the leading cause of death from gynaeocological cancer in the UK?
Insidious onset, late presentation
Most common type of ovarian cancer
Epithelial ovarian tumours
number of different subtypes- serous, endometrioid, mucinous etc
Commonest type of germ cell tumour
Dysgerminoma
Risk factors for the development of ovarian cancer
Lifestyle factors- smoking, obesity etc Anything which increases the number of ovulations (nulliparity late menopause/early menarche) Fhx of ovarian cancer BRCA1/2
Factors which are protective
Anything which inhibits/prevents ovulation- childbearing, breastfeeding, early menopause, oral contraceptive pill
What proportion of patients present with advanced (stage III/IV) disease? Why?
about 75%. Early symptoms are vague and non-specific e.g. abdominal discomfort, bloating, tiredness
Most common presentation
Pelvic or abdominal mass which may be painful (usually a late sign)
Investigations in suspected ovarian cancer? (4)
Serum CA-125 in post menopausal women
Pelvic and abdominal US
AFP and bHCG in women under 40
Image-guided FNA cytology
What algorithm is used to assess risk of malignancy?
Risk of malignancy index 1- US score x menopause score x CA-125 level
Stage I cancer
Limited to the ovaries
Cancer which is limited to the pelvis
Stage II
Stage III ovarian cancer
ovaries + peritoneal implants
Cancer involving the ovaries, with distant metastases
Stage IV
Metastases involving a) the liver capsule and b) the liver parenchyma is what stage?
a) III b) IV
What does standard surgery consist of in ovarian cancer?
Hysterectomy + salpingo-oophorectomy;
Peritoneal examination and washings;
Infracolic omentectomy;
Para-aortic and pelvic lymph node biopsy.
