Ovarian Cancer
Definition
3 types:
Metastatic from other areas:
Clincal Features
Vague and non-specific
Sx:
Investigations
Bloods:
DDx
Treatment
Prognosis
3-5y
Source
A/Prof Amanda Dennis 2014
Dr Ros Malley 2013
3 types:
- Epithelial (60-70%, usually benign.)
- Serous adenocarcinoma - CA125 (40% of malignant)
- Endometroid adenocarcinoma (20% of malignant)
- Mucinous adenocarcinoma - CA 125(10% of malignant)
- Clear-cell adenocarcinoma (poor prognosis)
- Paipllary adenocarcinomas (more aggressive and worse prognosis)
- Germ cell (15-20%, mostly benign cystic teratoma, 3-5% malignant)
- Teratoma (Mature = benign (dermoid cyst); immature (young girls), monodermal)
- Dysgerminoma
- Yolk sac (CA125, AFP)
- Choriocarcinoma (bHCG)
- Embryonic (bHCG)
- Sex chord stromal
- Granulosa cell (Ostrogen producing)
- Fibroma-thecoma cell (Meig's Syndrome)
- Sertoli-Leydig cell (androgen producing)
Metastatic from other areas:
- Krukenburg's tummour (from somach, LI, other GIT)
- Endometrium/ tube
- Breast
- Usually with normal core cf: 1o = core is tumours
Clincal Features
Vague and non-specific
Sx:
- Abdo pain
- Wt/ appetite loss, lethargy
- Backache
- Cramps
- Unexplained change in bowel habits
- Unusual vaginal bleeding
- Dyspareunia
- No signs in early disease, usually incidental dx
- Enlarged palpable ovary on bimanual exam
- Peripheral wt/ muscle tone loss
- Abdo distension
- Ascites
- Inguinal LN
Investigations
Bloods:
- CA-125 (serous epithelial Ca) cf pancreatic ca, appendicitis, fibroids
- AFP
- bHCG
- US (pelvic + transvaginal)
- CT, CXR for advanced disease
- Ascite/ Pleural tap (for histology to confirm ca)
DDx
- TB (multiple tumours everywhere) --> Need tissue dx!!
- Cystic ovarian mass <8cm in pre-menopausal = functional
- Unilocular cyst <5cm
- Multiloculated cysts or solid and cystic lesions
- Haemorrhagic corpus luteum (common young women)
- Endometriosis (common older women)
- Hydrosalpinges
- Benign Ovarian Fibroma (most common benign, older women) -> mx: surg
Treatment
- Maximal debulking (Surg)
- Chemo - Platinum based +/- Taxol
- Ref: gynae oncologist
Prognosis
3-5y
Source
A/Prof Amanda Dennis 2014
Dr Ros Malley 2013