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X - Cancer Care COPY > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

1
Q

How common is ovarian cancer?

A

It is the fourth most common cancer in the UK

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2
Q

What % of deaths in women aged 40-60 years does ovarian cancer account for?

A

5%

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3
Q

What is the average age of presentation of ovarian cancer?

A

60 years

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4
Q

What other cancers can share histological features with ovarian cancer?

A

Fallopian tube and peritoneal cancer

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5
Q

How is the management of fallopian tube and peritoneal cancer similar to that of ovarian cancer?

A

They are treated with a similar approach

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6
Q

What appears to protect against the development of ovarian cancer?

A

Suppressed ovulation

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7
Q

Give two examples of things that suppress ovulation

A
  • Prolonged breastfeeding

- High-oestrogen OCP

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8
Q

What % of women with ovarian cancer have a positive family history?

A

Up to 7%

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9
Q

What is the risk of ovarian cancer in patients with Peutz-Jeghers syndrome?

A

10%

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10
Q

What are the well recognised familial patterns occur in ovarian cancer?

A
  • Hereditary breast/ovarian cancer families

- Lynch type II families

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11
Q

What mutations do hereditary breast/ovarian cancer families have?

A

BRCA1 or BRCA2

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12
Q

What cancers are lynch type II families at increase risk of of?

A
  • Ovarian
  • Endometrial
  • Colorectal
  • Gastric
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13
Q

What mutations do lynch type II families have?

A

Mutations in mismatch repair enzymes

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14
Q

What kind of cancer is most common in the ovary?

A

Epithelial tumours

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15
Q

What % of ovarian cancers are epithelial tumours?

A

90%

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16
Q

What histological class of cancer do epithelial ovarian tumours include?

A

Adenocarcinomas

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17
Q

What are the potential histological appearances of adenocarcinomas of the ovary?

A
  • Serous
  • Mucinous
  • Endometrioid
  • Clear cell
  • Squamous cell
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18
Q

What are the other, rarer types of ovarian tumours?

A
  • Germ cell tumours
  • Carcinosarcomas
  • Sex cord tumours
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19
Q

In what ways to ovarian germ cell tumours resemble testicular germ cell tumours?

A

In histology and clinical management

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20
Q

What are the features of carcinosarcomas?

A
  • Aggressive

- More susceptible to haematogenous spread

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21
Q

What kinds of tumours does ovarian sex cord tumours include?

A
  • Granulosa cell tumours
  • Thecomas
  • Sertoli-Leydig cell tumours
  • Gonadoblastomas
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22
Q

What do sex cord ovarian tumours occasionally produce?

A
  • Oestrogens

- Androgens

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23
Q

What can oestrogens produced by sex cord ovarian tumours cause?

A
  • Precocious puberty

- Postmenopausal bleeding

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24
Q

What can androgens produced by sex cord ovarian tumours cause?

A

Virilisation

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25
Q

What are the symptoms of early stage ovarian cancer?

A

Asymptomatic in the majority of cases

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26
Q

When do most women with ovarian cancer present?

A

When they have advanced disease

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27
Q

What are the symptoms of advanced ovarian cancer?

A
  • Vague abdominal discomfort
  • Bloating
  • Altered bowel habit
  • Nausea and vomiting
  • Backache
  • Weight loss
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28
Q

What % of women with ovarian cancer present with advanced disease that is stage 3-4?

A

70%

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29
Q

Can ovarian cancer cause vaginal bleeding?

A

It is uncommon, and more likely to be Fallopian tube cancer

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30
Q

When is it important to consider and exclude ovarian cancer?

A

In a woman presenting with recent chance in bowel habit, or with vague abdominal symptoms

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31
Q

What systemic presentations of ovarian cancer are associated with more advanced disease?

A
  • Pleural effusions
  • Ascites
  • Malignant bowel obstruction
  • Thromboembolic phenomenon
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32
Q

How are umbilical peritoneal deposits from ovarian cancer metastasis sometimes seen?

A

As Sister Mary Joseph nodules

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33
Q

What are Sister Mary Joseph nodules?

A

Palpable nodules bulging from the umbilicus

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34
Q

What does the presence of Sister Mary Joseph nodules indicate?

A

Indicates transcoelomic spread and stage 4 disease

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35
Q

What lymph nodes should be checked in ovarian cancer?

A
  • Neck
  • Supraclavicular
  • Axillary
  • Inguinal
  • Para-aortic
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36
Q

What should be looked for on cardiovascular examination in ovarian cancer?

A
  • Pericardial effusion

- Loud P2

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37
Q

What might cause loud P2 on cardiovascular examination in ovarian cancer?

A

Pulmonary hypertension or PE

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38
Q

What should be looked for on general observation in ovarian cancer?

A
  • Viralisation
  • Ascites
  • Cachexia
  • Signs of dehydration
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39
Q

What should be looked for on skin examination in ovarian cancer?

A

Dermatomyositis

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40
Q

What should be looked for on genitourinary examination in ovarian cancer?

A
  • Haematuria

- PV discharge/bleeding

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41
Q

What should be looked for on respiratory examination in ovarian cancer?

A
  • Pleural effusion
  • Pleural rub
  • Tachypnoea
42
Q

What might cause pleural rub or tachypnoea on respiratory examination in ovarian cancer?

A

PE

43
Q

What should be looked for on abdominal examination in ovarian cancer?

A
  • Surgical scars
  • Umbilical nodules
  • Visible peristalsis
  • Bowel obstruction
  • Abdominal distention
  • Ascites
  • Hepatomegaly
  • Hepatic tenderness
  • Renal tenderness
  • Pelvic mass
  • Adenexal mass
44
Q

What should be looked for on neurological examination in ovarian cancer?

A
  • Focal neurological signs

- Cerebellar dysfunction

45
Q

Are focal neurological signs common in ovarian cancer?

A

No, they are rare

46
Q

What can cause cerebellar dysfunction in ovarian cancer?

A

Paraneoplastic syndromes

47
Q

What should be looked for on skeletal examination in ovarian cancer?

A

Focal bone tenderness

48
Q

What should be looked for on peripheral examination in ovarian cancer?

A

Calf tenderness

49
Q

What may calf tenderness indicate in ovarian cancer?

A

DVT

50
Q

What staging system can be used for ovarian cancer?

A

FIGO staging system

51
Q

What is a stage 1a ovarian cancer?

A

Tumour confined to one ovary

52
Q

What is a stage 1b ovarian cancer?

A

Tumour involving both ovaries, but no serosal involvement

53
Q

What is a stage 1c ovarian cancer?

A

Tumour that has one of the following features;

  • On the ovarian surface
  • Capsular breach or rupture
  • Malignant ascites
54
Q

What is stage 2a ovarian cancer?

A

Tumour has extended and/or implanted into the uterus and/or fallopian tubes.
Malignant cells are not detected in ascites or peritoneal washings

55
Q

What is stage 2b ovarian cancer?

A

Tumour that has extended to another organ in the pelvis.

Malignant cells are not detected in ascites or peritoneal washings

56
Q

What is stage 2c ovarian cancer?

A

Tumours that are stage 2a or b, but malignant cells are detected in the ascites or peritoneal washings

57
Q

What is stage 3a ovarian cancer?

A

Microscopic peritoneal metastasis beyond the pelvis.

No lymph node involvement

58
Q

What is stage 3b ovarian cancer?

A

Macroscopic peritoneal metastasis beyond the pelvis, but <2cm in greatest dimension

59
Q

What is stage 3c ovarian cancer?

A

Macroscopic peritoneal metastasis beyond the pelvis >2cm in greatest dimension, and/or regional lymph node metastasis

60
Q

What is stage 4 ovarian cancer?

A

Distant metastasis or parenchymal liver or other visceral metastasis, or malignant pleural effusion

61
Q

What investigations can be used to differentiate between benign ovarian cysts and ovarian malignancy?

A
  • Transvaginal ultrasound
  • Serum CA125
  • Age
62
Q

What is the sensitivity and specificity of investigations to differentiate between benign ovarian cysts and ovarian malignancy?

A

80-90%

63
Q

What additional use have transvaginal ultrasound and serum CA125 been studied for?

A

Population screening

64
Q

What might CT imaging be useful for in ovarian cancer?

A

To detect abdominal spread, including liver, lung, pleura, and lymph node involvementd

65
Q

How is the stage and extent of spread of ovarian cancer determined in ovarian cancer?

A

Surgery and the FIGO staging system

66
Q

What is the first line intervention for people with ovarian cancer?

A

Surgery

67
Q

What is the intention of surgery in ovarian cancer?

A

Debulking the disease

68
Q

What are the potential outcomes of debulking surgery in ovarian cancer?

A
  • Complete
  • Optimal
  • Suboptimal
69
Q

What is meant by complete debulking in ovarian cancer?

A

No macroscopic disease

70
Q

What is meant by optimal debulking in ovarian cancer?

A

Macroscopic disease <1cm

71
Q

What is meant by suboptimal debulking in ovarian cancer?

A

Residual disease >1cm

72
Q

What does surgery for ovarian cancer involve?

A
  • Laparotomy
  • Total hysterectomy
  • Bilateral salpingo-oophrectomy with omentectomy and lymph node resection
73
Q

What will the majority of women be candidates for after surgery for ovarian cancer?

A

Adjuvant chemotherapy

74
Q

What is neoadjuvant chemotherapy used for in ovarian cancer?

A

Patients with extensive disease at presentation

75
Q

What is the aim of neoadjuvant chemotherapy in ovarian cancer?

A

Shrink disease in order to consider interval debulking

76
Q

What treatment does non-epithelial ovarian cancer require?

A

Surgery following by chemotherapy

77
Q

What is the agent used for chemotherapy in non-epithelial ovarian cancer based on?

A

The predominant cell type present

78
Q

What % of patients diagnosed with ovarian cancer achieve remission?

A

80%

79
Q

What response rate is second-line chemotherapy associated with for relapse of ovarian cancer?

A

20-40%

80
Q

What are higher response rates to second-line chemotherapy in relapsed ovarian cancer associated with?

A

Greater treatment-free intervals

81
Q

What can serum CA125 be useful for in ovarian cancer?

A
  • Predicting relapse

- Predicting response to treatment

82
Q

How far ahead can CA125 predict relapse?

A

4.2 months

83
Q

Does early treatment of ovarian cancer based on CA125 levels alone give a survival advantage?

A

No

84
Q

What % of patients with ovarian cancer will relapse at some point?

A

Approx 60%

85
Q

What hormonal agents can be used in ovarian cancer?

A
  • Tamoxifen

- Aromatase inhibitors

86
Q

What is the use of hormonal approaches in ovarian cancer?

A

They can slow down the rate of progression, and delay onset of symptoms

87
Q

How will advanced ovarian cancer spread?

A

In a transcoelomic matter

88
Q

What may transcoelomic spread of ovarian cancer produce?

A
  • Ascites

- Subacute or complete bowel obstruction

89
Q

Why may transcoelomic spread of ovarian cancer produce bowel obstruction?

A

Due to serosal involvement of the bowel

90
Q

What might a pelvic mass caused by ovarian cancer lead to?

A

Hydronephrosis due to ureteric obstruction

91
Q

What might ascites caused by ovarian cancer require?

A

Frequent paracentesis

92
Q

What can be used to reduce the recurrence of pleural effusions caused by ovarian cancer?

A

Talc pleurodesis

93
Q

Why are patients with ovarian cancer at a particularly high risk of thrombosis?

A

Due to a prothrombotic tendency that correlates with disease activity

94
Q

What does the prognosis of ovarian cancer correlate with?

A

Stage at diagnosis

95
Q

What is the overall 5 year survival rate of ovarian cancer?

A

30%

96
Q

What is the 5 year survival rate of stage 1 ovarian cancer?

A

> 90%

97
Q

What is the 5 year survival rate of stage 4 ovarian cancer?

A

<25%

98
Q

What patients with ovarian cancer have a worse outcome?

A
  • Disease resistant to platinum therapy
  • Large volume residual disease following debulking
  • Clear cell histology
99
Q
  • Disease resistant to platinum therapy
  • Large volume residual disease following debulking
  • Clear cell histology
A

They are more likely to have visceral metastasis, but are more likely to respond to platinum therapy, and have longer treatment-free interval

100
Q

What is the best predictor outcome of ovarian cancer?

A

Achieving complete cytoreduction at initial surgery

X - Cancer Care COPY (36 decks)

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