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A1. Women's Health > Ovarian cancer > Flashcards

Flashcards in Ovarian cancer Deck (12):
1

Is screening for ovarian cancer currently done in Australia? Why/why not? What is the best current screening test?

No - tests aren't sensitive or specific enough. Would need 20 laparotomies to diagnose single cancer. Best method is a transvaginal U/S + Ca125

2

Name 2 populations where screening for ovarian cancer is warranted. If positive, name 2 interventions that can be done to prevent ovarian cancer and why.

People with strong family histories (or proven genotype) of BRCA1/2 mutations, or HNPCC (Lynch syndrome)

Mx - bilateral prophylactic oopherectomy (get rid of the ovaries) +/- salpingectomy (high grade serous ovarian cancers are believed to arise from the Fallopian tube)

3

What is the most accurate blood marker of ovarian cancer? Is it good - why/why not (2 main reasons)? Name 3 other conditions that might give a false positive result. Besides for screening/diagnosis, what is another use of this blood marker in ovarian cancer?

Ca125 - not great.

High false negative rate (50% of stage 1 ovarian cancer will have normal Ca125)

High false positive rate - premenopausal conditions (menstruation, fibroids, endometriosis, PID, pregnancy), cardiac or liver failure, peritonitis. Ca125 released from anything that irritates mesothelial surfaces (peritoneum, pleura). Often raised in pre-menopausal women.

Also used for monitoring response of Ca to therapy

4

Why is CEA often used as an investigation into an ovarian mass?

CEA released mainly from gut cancers, which can sometimes spread to ovary. Positive CEA + ovarian mass suggests a colorectal origin of the tumour, which needs very different management than a primary ovarian tumour (colorectal tumours respond poorly to surgery, ovarian tumours respond well to surgery)

5

What are the common features of history and examination of ovarian cancer? Name 3 differentials. Name 1 risk factor and 3 preventative factors.

History - usually > 65 years, often poorly defined symptoms - constitutional symptoms (anorexia, cachexia), abdominal swelling, abdo pain, dyspepsia, nocturia, dysuria

Examination - pelvic mass on pelvic examination

Ddx - Irritable bowel syndrome, metastases to the ovary, endometriosis, UTI, anaemia

Risk factor - nulliparity, FHx
Preventative factors - pregnancy, combined OCP, breast feeding

6

Name 3 investigations you should order if you are suspicious of ovarian cancer. What are the expected results if these Ix are positive?

Transvaginal U/S - solid and cystic mass +/- thickened septae, calcification, ascites, intraabdominal metastases. Reduced resistance to blood flow on Doppler studies (reflecting neovascularisation)

CT +/- PET - look for peritoneal thickening, enlarged lymph nodes, ascites, omental thickening, liver mets

CA125 and CEA - both may be raised

7

What index is often used to determine if a woman has a high chance of ovarian cancer? Name the 3 components of it

Relative malignancy index - based off menopausal status (higher if post-menopause), U/S features of cyst, and Ca125 levels.

8

Name 3 Ddx for an ovarian cyst seen on U/S

Benign - functional, dermoid, endometrioma, haemorrhagic
Malignant - epithelial, germ cell, stromal origin

9

Name 2 modes of management of an ovarian cancer. Name 3 ways of following up response to treatment

Surgery - often total abdominal hysterectomy + bilateral salpingo-oopherectomy (TAH-BSO)
Chemotherapy - usually platinum-based drugs

Use CA-125, CT, MRI to assess response to treatment

10

What is the most common type of ovarian cancer?

Serous adenocarcinoma

11

What would bilateral ovarian tumours suggest?

They may be a metastatic (not primary) ovarian cancer - 70% of bilateral ovarian tumours are mets

12

Name the 3 most common primary tumours that metastasise to the ovary. What proportion of ovarian tumours are metastatic?

GIT, breast, endometrial

5% are metastatic