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Flashcards in Ovarian cancer Deck (23):
1

What histological groups of ovarian tumours are there?

*Epithelial tumours
*Germ cell tumours
*Sex cord tumours

2

What are epithelial ovarian tumour's derived from? Types?

*Derived from epithelium covering the ovary, or serous adenocarcinomas, the fallopian tube

Types:
*serous cystadenoma or adenocarcinoma =malignant
*endometrioid carcinoma =malignant
*clear cell carcinoma =malignant
*mucinous cystadenoma or adenocarcinoma =malignant
*brenner tumours =benign

3

Which sites metastasize to the ovary?

Breast and gastrointestinal tract

4

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

5

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%

6

What are germ cell ovarian tumour's derived from? Types?

*Originate from undifferentiated primordial germ cells of the gonad and account for 3%

Types:
*Teratoma or dermoid cysts (benign)
*Yolk sac tumours (malignant)
*Dysgeminoma (malignant)

7

What a sex cord tumours derived from? Types?

Originate from the stroma of the gonad and account for <2%

Types:
*Granulosa cell tumours (malignant & rare)
*Thecomas (benign & rare)
*Fibromas (benign & rare)

8

What are the most common type in the rare event of a woman under the age of 30 getting ovarian cancer?

Germ cell tumours

9

What are the risk factors for getting ovarian cancer?

*Family Hx
*BRCA1 and BRCA2
*age
*smoking
*obesity
*many ovulations: early menarche, late menopause, nulliparity

10

What are the clinical features of ovarian cancer? How do they present?

History:
*notoriously vague
*abdominal distension and bloating
*urinary symptoms e.g. urgency
*early satiety
*diarrhoea
*many similar to IBS symptoms
*important to ask about breast and GI symptoms

Examination:
*cachexia
*abdo/pelvic mass
*ascites
*breasts should be palpated for masses

11

What staging is used for ovarian cancer?

FIGO

12

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

Stage 2:
Disease extending to the pelvis

Stage 3:
Abdo disease and/or affected lymph nodes

Stage 4:
Disease is beyond the abdomen e.g. lungs

13

What makes it more likely that the ovarian mass is malignant?

*rapid growth >5cm
*ascites
*advanced age
*bilateral masses
*solid or septate nature on USS
*increased vascularity

14

What investigations are done when ovarian cancer is suspected?

*CA125 blood test
*USS
*in women under 40, alpha fetoprotein and hCG are measured (raised in germ cell tumour)

15

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

16

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:
*mutilocular
*cysts
*solid arease
*metasteses
*ascites
*bilateral lesions

Menopausal status point:
1 = premenopausal
3 = postmenousal

17

What levels of CA125 suggest the need for an urgent ultrasound scan?

*35 IU/mL or greater

18

What is CA125?

*Blood test
*Tumour marker
*produced by some ovarian cancer cells

19

What is the management of ovarian cancer?

*Combination of surgery and platinum based chemotherapy
*assessment of fitness for surgery

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

20

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

21

What are protective factors against ovarian cancer?

*pregnancy
*breastfeeding
*early menopause
*COCP

22

What is the most common cause of death from gynaecological cancers?

*Ovarian cancer

23

What are tumour like conditions of the ovary?

*Endometriotic cysts
*Follicular cysts
*Lutein cysts