Ovarian Cancer
- Most common gynaecological malignancy
- Most often in women aged 45-60
- Life time risk of 1%
- Overall survival of 30%
- Familial predisposition (5-10%) - BRCA I, BRCA II, Lynch II syndrome (hereditary non-polyposis colorectal cancer)
- Less common with oral contraception, increased pregnancies, longer duration of breast feeding and early menopause
- Incidence related to number of ovulatory cycles
- Major risk factors nulliparity and a family hx
- Associated with mutations in p53 and Rb
- 90% are adenocarcinomas arising from the epithelial cells on the ovary surface
Clinical Presentation
- Often referred to as a ‘silent’ disease – 60% of patients present with advanced disease
- Can present with abdominal discomfort and fullness due to ascites
- May be changes in bowel habit, urinary frequency and colicky pain
- General malaise and weight loss
- Abdo examination may reveal ascites, ‘omental cake’ or umbilical lymph node involvement (Sister Jospeh’s node)
- Vaginal or rectal examination may reveal masses in the Pouch of Douglas
- Local metastic deposits may be present in the cervix, vagina and vulva
- Distant metastases may be malignant pleural effusion, parenchymal liver deposits, axillary or inguinal lymph node deposits, subcutaneous nodules or brain metastases
- Spread of ovarian cancer
· Transperitoneal
· Lymphatic – para- aortic, external iliac and hypogastric nodes, inguinal nodes
Pathology
- Serous – most common (50%)
- Endometroid – (30%) may arise from malignant transformation of the endometrium
- Mucinous – (20%)
- Natural history not well understood, no known premalignant change
Investigations
- FBC
- U&E’s
- Liver function tests
- CXR
- Ultrasound of abdomen
- CA125 (can be raised in pregnancy, endometriosis, pelvic inflammatory disease, benign ovarian cysts, cirrhosis, pericarditis, pleurisy)
- Laproscopic surgery
Staging
- Stage 1 - confined to ovaries
- Stage 2 – involvement of other pelvic structures
- Stage 3 – involvement above pelvic brim
- Stage 4 – spread throughout peritoneal cavity
Surgery
- Basic operation – bilateral salpingo-oophorectomy, total hysterectomy, omentectomy, appendectomy and selective lymphadenectomy
- Aims – diagnosis, staging, debulking
- Bowel most common site of metastases in advanced disease
- ‘Interval’ debulking refers to operations that take place are a number of courses of chemotherapy without previous initial debulking surgery
Chemotherapy
Mostly carboplatin in combination with paclitaxol
Paclitaxol causes alopecia
Carboplatin side effects are myelosuppression
Chemotherapy response rate 70% but most patients will relapse often with drug resistant disease (mean time 18 mth)