ABC Medical Notes.com

About

• Leading cause of death and 8% of cancers in women
• Incidence falling with use of Contraception

Aetiology

• Risk with increasing age

Clinical

• Bloating/abdominal distension, urinary incontinence, urgency
• Early satiety, pelvic and abdominal pain
• Unexplained weight loss, fatigue or changes in bowel habit.
• Diagnosis is often delayed and late

Differentials

• Early symptoms misdiagnosed as Irritable bowel syndrome which is rare in onset in those over 50

Investigations

• FBC/ESR - anaemia
• Elevated CA-125 in some but not all (false positive in menstruation). If serum CA125 is 35 IU/ml or greater, arrange an ultrasound scan of the abdomen and pelvis. For any woman who has normal serum CA125 (less than 35 IU/ml), or CA125 of 35 IU/ml or greater but for a normal ultrasound: assess her carefully for other clinical causes of her symptoms and investigate if appropriate if no other clinical cause is apparent, advise her to return to her GP if her symptoms become more frequent and/or persistent.
• AFP and B HCG: In women under 40 with suspected ovarian cancer, measure levels of alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG) as well as serum CA125, to identify women who may not have epithelial ovarian cancer.
• Pelvic Ultrasound - may show mass or ascites
• CT scan Abdomen/Pelvis: if the ultrasound, serum CA125 and clinical status suggest ovarian cancer, perform a CT scan of the pelvis and abdomen to establish the extent of the disease. Include the thorax if clinically indicated.
• Biopsy: If offering cytotoxic chemotherapy to women with suspected advanced ovarian cancer, first obtain a confirmed tissue diagnosis by histology (or by cytology if histology is not appropriate) in all but exceptional cases.

Staging

Stage I

• Stage I (T1-N0-M0): The tumour is limited to the ovaries or fallopian tubes.
• Stage IA (T1a-N0-M0): Only one ovary or fallopian tube is affected by the tumour, and the ovary is intact. No cancer is detected on the surface of the ovary or fallopian tube and there are no malignant (cancerous) cells detected in fluid taken from the abdomen.
• Stage IB (T1b-N0-M0): Both ovaries (or fallopian tubes) are affected by the tumour, but both ovaries are intact. No cancer is detected in either the surface of the ovaries or fallopian tube or in the fluid from the abdomen.
• Stage IC: The tumour is limited to one or both ovaries or fallopian tubes, with any of the following:
• Stage IC1: (T1C1-N0-M0: The ovary capsule is ruptured (no longer intact) as a result of the surgery.
• Stage IC2: (T1C2-N0-M0): The ovary capsule ruptured before surgery, or there is a detectable tumour on the ovary or fallopian tube surface.
• Stage IC3: (T1C3-N0-M0: Cancerous cells are detected in the fluid taken from the abdomen.

Stage II

• Stage II (T2-N0-M0): The tumour is in one or both ovaries, or fallopian tubes, and has extended into the pelvis or the peritoneum (thin flexible sheet of transparent tissue that covers the organs inside your abdomen).
• Stage IIA (T2a-N0-M0): The cancer is also affecting the uterus and/or fallopian tubes
• Stage IIB (T2b-N0-M0): The cancer is affecting other organs in your pelvis

Stage III

• Stage III (T1/T2-N1-M0): The tumour is in one or both ovaries, or fallopian tubes, or the peritoneum, and has also extended to the lining of the pelvis and abdomen and/or nearby lymph nodes.
• Stage IIIA1 (T1/2-N1-M0): Very tiny cancer cells are detected in the lymph nodes in the lining of the abdomen. (Stage IIIA1(i) the tumour is up to 10 mm in dimension, and Stage IIIA1(ii) the tumour is more than 10 mm in greatest dimension).
• Stage IIIA2 (T3a2-N0/N1-M0): Very tiny cancer cells are detected above the pelvis, with or without the tumour detectable in the lymph nodes in the lining of the abdomen.
• Stage IIIB (T3b-N0/N1-M0): Small tumours (less than 2cm in diameter) are detectable beyond the pelvis, and the lymph nodes may or may not contain cancerous cells.
• Stage IIIC (T3c-N0/N1-M0): Small tumours (more than 2cm in diameter) are detected beyond the pelvis, including into the non-functional part of the liver and spleen and/or there is cancer.

Stage IV

• Stage IV - A and B (any T-any N-M1): The cancer cells have spread to another organ such as the liver, the brain or the lungs.

Management

• Chemotherapy: Platinum based chemotherapy is widely used to treat ovarian cancer. Most commonly carboplatin is used, and sometimes cisplatin or paclitaxel (also known as Taxol). It is standard practise to give chemotherapy once every three weeks for six cycles. However, giving smaller weekly doses over an 18 week period is becoming more common, as there appears to be some clinical benefit and increased tolerance.
• Debulking Surgical resection

References