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Typically affects women aged 50–60. Usually presents very late with a poor prognosis, so therefore be highly suspicious of a woman presenting with any of the symptoms. It has a very poor prognosis in the later stages. Ovaries are a common site for secondary mets, especially from breast and GI cancers.
- Abdominal distension
- Abdominal pain (rupture, haemorrhage, torsion)
- Weight loss
- Urinary frequency
- PMP and abnormal menses
- An incidental finding on a scan
- Early menarche
- Late menopause
This is due to more ovulation, so more damage to the ovary, so more cell replication therefore a higher risk of cancerous cells developing.
- BRCA 1 and BRCA 2 are tumour supressor genes which increase the risk
Multiparity, lactation and the combined oral contraceptive pill are protective factors.
USS and tumour marker (CA125) are the main investigations, however the marker is not specific to ovarian cancer; it can be raised in other conditions such as Endometriosis but also in other tumour types, and in any cause of inflammation. Older women who present with IBS type symptoms need to be investigated for Ovarian cancer.
Surgical; total hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy. Biopsy +/- lymph nodes. + chemo
- Stage 1 – confined to ovary
- Stage 2 – pelvic spread
- Stage 3 – abdominal spread
- Stage 4 – distant mets
As soon as the cancer spreads out of the ovary (stage 2) prognosis is very bad.
Cysts pre menopausal are likely normal, tertiary follicles containing eggs. Cysts are typically <5 cm. Cysts are very worrying in post menopausal women.