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Ovarian Cancer

Background Knowledge ๐Ÿง 

Definition

  • A malignancy arising from the ovarian tissue.
  • Includes epithelial, germ cell, and stromal tumours.
  • Most common subtype is epithelial ovarian cancer.
  • Often diagnosed at an advanced stage.

Epidemiology

  • Fifth most common cancer in women in the UK.
  • Higher incidence in postmenopausal women.
  • Lifetime risk approximately 1 in 52.
  • Higher rates in developed countries.

Aetiology and Pathophysiology

  • Genetic mutations (BRCA1/BRCA2, Lynch syndrome).
  • Prolonged ovulation and hormonal factors.
  • Chronic inflammation and epithelial damage.
  • Early menarche and late menopause increase risk.
  • Protective factors: Oral contraceptives, pregnancy, breastfeeding.

Types

  • Epithelial tumours: Serous, mucinous, endometrioid, clear cell.
  • Germ cell tumours: Dysgerminoma, teratoma, yolk sac tumour.
  • Sex cord-stromal tumours: Granulosa cell tumour, thecoma.
  • Metastatic tumours: Krukenberg tumour (from GI tract).

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • Abdominal bloating and distension.
  • Pelvic or abdominal pain.
  • Early satiety and loss of appetite.
  • Urinary urgency or frequency.
  • Altered bowel habits (constipation or diarrhoea).
  • Unintentional weight loss.

Signs

  • Pelvic mass on physical examination.
  • Ascites (fluid in the abdomen).
  • Pleural effusion (fluid around the lungs).
  • Lymphadenopathy (enlarged lymph nodes).
  • Cachexia (severe weight loss and muscle wasting).

Investigations ๐Ÿงช

Investigations

  • Blood tests: CA-125 marker, FBC, U&Es, LFTs.
  • Pelvic ultrasound for initial assessment.
  • CT/MRI for detailed imaging and staging.
  • Histological examination of biopsy or surgical specimen.
  • Genetic testing for BRCA1/BRCA2 mutations.

Management ๐Ÿฅผ

Management

  • Surgical debulking (optimal cytoreduction).
  • Chemotherapy: Platinum-based (carboplatin) and taxanes (paclitaxel).
  • Targeted therapy: PARP inhibitors (for BRCA-mutated cancers).
  • Hormonal therapy: For certain stromal tumours.
  • Palliative care for advanced disease.

Complications

  • Bowel obstruction.
  • Ascites causing discomfort and respiratory issues.
  • Pleural effusion leading to dyspnoea.
  • Venous thromboembolism.
  • Peritoneal carcinomatosis.

Prognosis

  • Five-year survival rate: Approximately 46% in the UK.
  • Better prognosis with early-stage detection.
  • Advanced-stage disease has poorer outcomes.
  • Regular follow-up essential for monitoring recurrence.
  • New therapies improving outcomes over time.

Key Points

  • Early detection and regular screening in high-risk individuals.
  • Multidisciplinary approach to management.
  • Awareness of symptoms critical for early intervention.
  • Genetic counselling for families with BRCA mutations.

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