Ovarian Cancer Flashcards
(31 cards)
Mortality rate
Leading cause of gynae death
1000 diagnosed per year
900 women die per year
Lifetime incidence
1.7%
Majority not hereditary (10-15% are)
5 year survival rates by stage
I: 90%
II:80%
III: 15-50%
IV: 5-15%
**most patients diagnosed at stage III
Epithelial type cancers
75% of all ovarian cancers are epithelial
Serous:45% Mutinous:25% Endometriod:15% Clear cell: 10% Transitional
Germ cell type
15-20%
Dysgerminoma
Yolk sac tumour
Choriocarcinoma
Immature teratoma
Sex-cord stromal types
5%
Granulosa
Thecoma
Fibroma
Sertoli-leydig
Risk factors for ovarian cancer
Age Early age menarche Late age menopause Infertility Nulliparity Late childbirth (age>35) Caucasian race Endometriosis
Heridarty syndromes BRAC1 40% BRAC2 15-20% HNPCC 10-15% Fam hx 5% if one first degree relative; 7% if two
Pathophysiology of ovarian cancer
Fallopian tube as site of origin
Transfer of normal and abnormal tubal epithelium to ovary
After ovulation, tubal cells implant on denuded ovarian surface
? Only in BRAC+
Ca 125 - value of
Elevated in 80% of stage III disease
Poor sensitivity (only elevated in 50% of women with stage 1)
Specificity problematic
-elevated in ~1% healthy woman
-may fluctuate during menses
- associated with common, benign conditions (endo, fibroids, PID, adenomyosis, pregnancy)
Forms of risk reduction
OCPs (30-60% RR, increased w duration of use) - BRCA gene women offer
BFing
Tubal ligation
BSO :opportunistic salpingectomy, role in BRCA gene fault carriers and Lynch syndrome; reduces risk of breast cancer in BRCA gene fault carriers
Differential diagnosis of pelvic mass
Benign: Functional cyst Leiomyomata Endometritis TOA Ectopic Teratoma Cystadenoma
Borderline
Malignant
Epithelial
Germ cell
Sex-cord stromal
Non gynae: diverticula disease, pelvic kidney, colon ca breast ca, gastric ca
Tumor markers for epithelial
Ca-125
CEA
Ca 19-9
He4
Germ cell tumor markers
LDH
AFP
B-hcg
Inhibin
Sex cord stromal tumor markers
E2
FSH
Inhibin
Testosterone
Spread patter on epithelial
Symptoms 3-6 months
Local extension
Transpertoneal (upper/lower abdo)
Lymphatic spread
Treatment choices by grade and stage
Observe: stage IA/B, grade 1-2
Chemo: Stage IA/B, grade 3; Stage IC any grade and Stage II
Procedures to achieve cytoreduction for advanced disease
TAH/BSO One texting Peritoneal implant resection Resection of rectosigmoid Small bowel resection Diaphragmatic stripping Splenectomy, hepatectomy, distal pancreatectomy, urologic, abdominal wall Lymphadenectomy
Then Chemo
If not surgical candidate - straight to chemo for 3-4 cycles then consider cytoreduction, then complete chemo
Not debulkable
Bulky upper abdominal disease
Large volume ascites with extensive serosal disease
Extra-abdominal disease or intra-hepatic mets
Low grade serous ovarian carcinoma
Younger women
Better prognosis
Chemo-resistant
RMI >200 spec and send
97% and 87%
More useful postmenopausal
Invx
routine bloods incl clotting profile Ca125, CEA CXR - if ascites or need pleural tap CT and USS Colonoscopy, gastroscope if indicated
Stage 1
Limited to ovary
A: 1 ovary
B: both ovaries
C: surface involvement, +ve washings
Stage 2
Pelvic extension
A: aerosol uterine/tubal disease
b: other pelvic structures
C: with positive washings
Stage 3
Outside pelvis
A: microscopic Mets
B: macroscopic Mets <2cm
C: >2cm/ nodal Mets
