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Ovarian cancer (Risk factors (Nullpatity, Talcum powder (on genital area)…
Ovarian cancer
Risk factors
Nullpatity
Talcum powder
(on genital area)
Late menopause
Genetics
(BRCA1>BRCA2, HNPCC)
Early menarche
Clinical
presentation
Persistent bloating
Increased girth
Urinary symptoms
Change in bowel habit
PV bleeding
Diagnosis
Examination
Abdominal
Supraclavicular LNs, masses,
bloating, ascites
Pelvic
Masses (fixed/mobile)
Speculum
Nil
Investigations
Bloods
FBC, U+E, LFTs (albumin)
Ca markers: CA125 (ovary), CA19.9 (ovary, others), CEA (CRC),
rarer markers (AFP, hCG, LDH, inhibin, oestradiol)
Bedside
Obs (sats, RR, HR, BP, temp)
Imaging
Abdo/pelvic USS: mass, ascites
CXR: metastases, pleural effusion
CT abdo/pelvis: omental cake, peritoneal deposits, other mets
Laparotomy: diagnostic and staging
Cytology
Pleural/ascitic fluid, peritoneal washings
History
POH
Gravity/parity, conception,
delivery, complications
PMH
Medical conditions
Abdo surgery
PGH
Known gynae disease,
menses (menarche and menopause),
contraception/HRT, STIs, smears
DH
Current meds, allergies
PC/HPC
Bloating, PV bleeding, urinary/bowel,
weight loss, night sweats
FH
Cancers (breast, ovary, bowel)
SH
Occupation, smoking, alcohol
Staging (FIGO)
Stage 2
Limited to pelvis
(uterus, tubes, other structures)
Stage 3
Limited to abdomen
(regional LNs, micro/macromets)
Stage 1
Limited to one/both ovaries,
capsule, ovarian surface
Stage 4
Distant mets outside abdomen
(e.g. pleura, liver, spleen, distant LNs)
Pathophysiology
Ovulation theory
Damage to ovary surface epithelium during ovulation
Thus higher risk if more ovulations, and reduced risk if ovulation is suppressed (e.g. PCOS, tubal ligation, pregnancy, COCP)
Location
May arise in ovary or fallopean tubes
Can spread throughout pelvis locally and abdomen
Spread to peritoneum and omentum - omental cake
Types
Epithelial (90%)
Serous cystadenocarcinoma (commonest)
Mucinous, endometroid cystadenocarcinoma
Clear cell, undifferentiated
Germ cell (5%)
Dysgerminoma (commonest; often abnormal gonads e.g. Turner's)
Embryonal carcinoma
Teratomas (young girls)
Endometrial sinus tumours/yolk sac tumours (young, high AFP)
Choriocarcinoma (young, high hCG and AFP)
Sex cord stromal (5%)
Granulosa cell (young, post-menopausal, high inhibin and oestradiol)
Sertoli/Leydig cell (make androgens)
Management
Medical
Adjuvant RT
Indication: alongside surgery, advanced disease, palliation
MOA: kill residual microscopic cells
Adjuvant chemotherapy
Indication: alongside surgery, advanced disease, palliation
E.g. platinum agents cisplatin, carboplatin
Indication: killing of residual cells
Surgical
Laparotomy
Indication: 1L low grade disease
MOA: removal of macroscopic tumour
(hysterectomy, BOS, omentectomy, LNs, peritoneal washings)
Conservative
Information, advice, support
Ovarian cancer specialist nurse
Drainage ascites/pleural effusions
Follow up (clinical, tumour markers for 5y)
Epidemiology
Leading cause of death
from gynae malignancy
Elderly (74-85y)
Definition
Malignant neoplasm
of the ovaries
Prevention
Screening
Indication: high risk (2 breast/ovary primary
in a 1st/2nd degree relatives)
Method: BRCA1/2 screening for mutations
Management: surveillance (CA125, TV USS),
prophylactic BSO, full hysterectomy