Flashcards in Ovarian cancer Deck (23):
What histological groups of ovarian tumours are there?
*Germ cell tumours
*Sex cord tumours
What are epithelial ovarian tumour's derived from? Types?
*Derived from epithelium covering the ovary, or serous adenocarcinomas, the fallopian tube
*serous cystadenoma or adenocarcinoma =malignant
*endometrioid carcinoma =malignant
*clear cell carcinoma =malignant
*mucinous cystadenoma or adenocarcinoma =malignant
*brenner tumours =benign
Which sites metastasize to the ovary?
Breast and gastrointestinal tract
What is the epidemiology of ovarian cancer?
*lifetime risk is 1 in 60
*Rates increase with age
*median age of diagnosis is 63 years
*rates decreasing due to widespread used of Oral contraceptives
Most common histological type of primary ovarian malignancy? 2nd and 3rd?
1. Serous adenocarcinoma (high and low grades) =75%
2. Endometrioid carcinoma 10%
3. Clear cell carcinoma 10%
What are germ cell ovarian tumour's derived from? Types?
*Originate from undifferentiated primordial germ cells of the gonad and account for 3%
*Teratoma or dermoid cysts (benign)
*Yolk sac tumours (malignant)
What a sex cord tumours derived from? Types?
Originate from the stroma of the gonad and account for <2%
*Granulosa cell tumours (malignant & rare)
*Thecomas (benign & rare)
*Fibromas (benign & rare)
What are the most common type in the rare event of a woman under the age of 30 getting ovarian cancer?
Germ cell tumours
What are the risk factors for getting ovarian cancer?
*BRCA1 and BRCA2
*many ovulations: early menarche, late menopause, nulliparity
What are the clinical features of ovarian cancer? How do they present?
*abdominal distension and bloating
*urinary symptoms e.g. urgency
*many similar to IBS symptoms
*important to ask about breast and GI symptoms
*breasts should be palpated for masses
What staging is used for ovarian cancer?
What are the FIGO stages for ovarian cancer?
Stage 1: Disease macroscopically confined to the ovaries
a. one ovary
b. both ovaries
c. tumour on surface/rupture
Disease extending to the pelvis
Abdo disease and/or affected lymph nodes
Disease is beyond the abdomen e.g. lungs
What makes it more likely that the ovarian mass is malignant?
*rapid growth >5cm
*solid or septate nature on USS
What investigations are done when ovarian cancer is suspected?
*CA125 blood test
*in women under 40, alpha fetoprotein and hCG are measured (raised in germ cell tumour)
What is the risk of malignancy index? How is it calculated?
Score calculated from:
*Ultrasound scan (U)
*menopausal status (M)
*CA 125 levels
U x M x CA125
*All women with a score of equal to or over 250 are referred to a specicialist MDT
In the risk of malignancy index score, what are the points given to USS and menopausal status?
USS Scored 1 point for each of the following characteristics:
Menopausal status point:
1 = premenopausal
3 = postmenousal
What levels of CA125 suggest the need for an urgent ultrasound scan?
*35 IU/mL or greater
What is CA125?
*produced by some ovarian cancer cells
What is the management of ovarian cancer?
*Combination of surgery and platinum based chemotherapy
*assessment of fitness for surgery
*total hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy
*in women wishing to preserve fertility, where disease appears early or is borderline , uterus and unaffected ovary may be preserved
What is the follow up of someone who has had ovarian cancer?
*Levels of CA 125 are useful after as well as during chemo
*CT scanning aids detection
*interval debulking of residual tissue, if not all could be removed at first surgery
What are protective factors against ovarian cancer?
What is the most common cause of death from gynaecological cancers?