Pelvic masses and ovarian cancer Flashcards
(51 cards)
What are risk factors for the development of ovarian cancer?
- BRCA1/2
- HNPCC
- Early menarche/Late menopause
- Previous breast cancer
- Asbestos
- Nulliparity
- Smoking
- Obesity/Diabetes
- “Incessant ovulation”
What factors protect against the development of ovarian cancer?
- Pregnancy
- Breastfeeding
- COCP
- Tubal ligation
- Hysterectomy
- Exercise
- Aspirin
When would you consider referring someone for genetic counselling if the had ovarian cancer?
- Two primary cancers in one 1st/2nd degree relative
- Three 1st/2nd degree relatives with breast, ovary, colorectal, stomach or endometrial cancers
- Two 1st/2nd degree relatives - 1 with ovarian cancer any age, and other with breast cancer age < 50
- Two 1st/2nd degeree relative with ovarian cancer any age
How does ovarian cancer present?
Often vague symptoms:
- Bloating
- Unexplained weight loss/Loss of appetite/early satiety
- Fatigue
- Urinary symptoms - Frequency/urgency
- Change in bowel habits
- Abdominal/Pelvic pain
- Vaginal bleeding
- Pelvic mass
What can ovarian cancer present like?
- IBS
- Diverticular disease
What might you find on examination in someone with ovarian cancer?
- Fixed abdominal/pelvic mass
- Ascites
- Omental mass
- Pleural effusion
- Supraclavicular lymphadenopathy
What are the main types of ovarian tumours?
- Epithelial
- Germ cell
- Sex cord-stromal
- Metastatic
- Miscellaneous
Where do epithelial cell tumours arise from?
Mesothelial layer covering the peritoneal surface of the ovary and associated inclusion cysts
What are different types of epithelial ovarian cancers?
- Serous
- Mucinous
- Endometroid
- Clear cell
- Brenner
- Mixed epithelial
- Mixed mullerian
What are the different types of germ cell malignancies seen in ovarian cancers?
- Dysgerminoma
- Teratoma
- Yolk sac tumour
- Choriocarcinoma
What are the different types of sex cord-stromal tumours?
- Thecoma
- Granulosa cell tumour
- Androblastoma
- Gonadoblastoma
- Fibroma
What investigations would you consider doing in someone with suspected ovarian cancer?
- Examine Abdo and Pelvis
- Bloods - FBC, U+E’s, LFTs, CA-125, CA 19-9, AFP, BHCG, placental ACP, LDH, serum inhibin
- Imaging - Pelvic US, CXR, CT abdo/pelvis, MRI
- Other - ascitic tap/pleural tap, biopsy
What might you see on pelvic USS in someone with ovarian cancer?
Presence of solid, complex, septated, multi-loculated mass, with high blood flow
When would transvaginal ultrasound be used when investigating ovarian cancer?
If pelvic mass palpated on examination
What is CA-125?
Glyco-protein used in detecting and monitoring epithelial ovarian tumours
What proportion of epithelial cancers is CA-125 positive in?
80%
What else can elevate CA-125?
- Endometriosis
- Uterine fibroids
- Pregnancy
- Ovarian cysts
- Pancreatic, breast, lung, gastric and colon cancer
How would you make the diagnosis of ovarian cancer?
- Extirpation of affected ovary
- Pleural/ascitic fluid aspiration
Why might you do CXR in someone with suspected ovarian cancer?
- Look for pleural effusion, lung mets
- Used in staging
How is the risk of malignancy index calculated?
US x M x CA125
- US = US score (1-3)
- M = Menopausal status (1 - pre, 2-peri, 3 - post)
- CA125 = serum CA125 levels
What is the scoring for US scan based on when calculating RMI index?
Presence of one of the following scores 1 point, presence of 2 scores 2 etc:
- Multilocularity
- Solid areas
- Metastases
- Ascites
- Bilaterality of lesions
What RMI score is regarded as high risk?
>250 - 75% risk of cancer
What RMI score is regareded as low risk?
<25 - <3% risk of cancer
What are functional ovarian cysts?
Enlarged or persistent follicular or corpus luteum cysts. They are so common that they may be consdiered normal if they are small. They can cause pain if ruptured
