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Ovarian Cancer

From Mediwikis
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Ovarian Tumour

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.

Symptoms

  • Asymptomatic
  • Abdominal distension
  • Abdominal pain (rupture, haemorrhage, torsion)
  • Indigestion
  • Weight loss
  • Urinary frequency
  • PMP and abnormal menses
  • An incidental finding on a scan

Risk factors

  • Early menarche
  • Late menopause
  • IVF

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.

Investigations

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.

Management

Surgical; total hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy. Biopsy +/- lymph nodes. + chemo

Staging

  • 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.

Ovarian Cysts

Cysts pre menopausal are likely normal, tertiary follicles containing eggs. Cysts are typically <5 cm. Cysts are very worrying in post menopausal women.