Ovarian Cancer

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Definition

-   

 

Features

-  5th most common cause of Ca death in women

-  40% 5yr survival

-  Prevelance 45/100,00 women >40yrs old

-  Lifetime risk 1.2%

-  Mortality 36/100,000

-  Usually presents at Stage III

-  80% at stage 2+

 

Risk Factors

-  60-70 yrs old

-  5-10% have BRCA 1/2 or HNPCC

-  Reproductive factors

-  Number of ovulations: early menarche, late menopause

-  Each pregnancy decreases risk by 10-15%

-  Breast feeding is protective

-  OCP 50% decreased risk if ever used (> 5yrs)

-  Incessant Ovulation Hypothesis

 

Types

-  Surface epithelial 80-85%

-  90% of malignant ovarian Ca

-  Serous most common: Psamoma bodies of path

-  Others: mucinous, endometroid, clear cell, Brenner, cystadenofibroma

-  Uncommon <40yrs

-  50% from fimbrial part of fallopian tube

-  Germ cell 5%

-  Callexinar bodies, high oestrogen

-  Teratoma, choriocarcinoma, dysgemninoma

-  Sex chord (Stromal) 2-3%

-  Usually benign

-  Granulosa cell

-  Metastasis 5%: breast Ca, GIT Ca

 

Associated S/S

-  Abdo pain/tenderness/distension

-  DDx IBS

-  Constipation, diarrhoea

-  Abdominal mass

-  Weight gain

-  Metasasis

-  Intraperitoneal spread +/- nodes (omental cake): ascities

-  Pleural cavity + lung: pleural effusion

-  Rarely haematogenous

 

Ix

-  VE + bimanual:

-  +/- PR

-  Tumour markers

-  CA125: insensitive, low spec

-  Beta HCG

-  LDH

-  AFP

-  CEA: to exclude bowel Ca

-  LFTs, U&E: mets

-  Pelvic US +/- TV

-  CXR: pleural effusion

-  +/- MRI/CT: mets, staging, mass, omental cake, ascities

 

DDx

-  Borderline tumours

-  Conservative Mx

-  Expert pathology R/V to confirm Dx

-  By S/S: IBS

-  By CA125: CEA (Bowel Ca)

-  Ovarian cyst

-  If <5cm & N CA125 repeat US in 4-6 weeks

-  If >5cm or abnormal CA125 refer to gynaecologist

-  Complex cyst postmenopausal = abnormal = refer

-  Endometriosis

 

Staging

-  I: ovaries only

-  II: extension to pelvis

-  III: extension beyond pelvis

-  Usual presentation

-  IV: mets: liver, pleura

 

Mx

-  Surgery (cytoreduction, debulking)

-  Bilateral oopherectomy + chemotherapy

-  Laparoscopic if benign, laparotomy if malignant or unknown

-  + complete hysterectomy if malignant +/- bowel resection

-  Debulk + staging

-  Chemotherapy

-  Carboplatin + Taxane

-  70-80%% respond

-  Relapse w resistance to chemo common

-  Radiotherpy: palliation