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Ovarian Cancer

This has the worst prognosis of all the gynaecological cancers as it often presents late - > 70% present after it has spread beyond the pelvis.


The most common type of it are Epithelial cell tumours. Other types include:

  • Germ cell tumours/ Dermoid cysts – Benign – can contain skin, teeth, hair and bone

  • Sex cord-stromal tumours

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“A pathological specimen of ovarian carcinoma.” © CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

Risk factors:

  • Older age

  • BRCA1/2 +ve

  • Increased number of ovulations – Early menarche, Late menopause, Nulliparity

  • Obesity

  • Smoking

  • HRT


Protective factors:

  • Pregnancy

  • Breastfeeding

  • COCP

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“BRCA1 and BRCA2 mutations and absolute cancer risk.” © Mikael Häggström, M.D. CC0 1.0 (https://en.wikipedia.org/wiki/File:BRCA1_and_BRCA2_mutations_and_absolute_cancer_risk.jpg)

Presentation

Symptoms develop late and are often non-specific

  • Bloating

  • Early satiety/Loss or appetite

  • Pelvic pain

  • Urinary symptoms (urgency/frequency)

  • Hip/Groin pain – Ovarian mass can press on Obturator nerve lateral to it


Investigations

  • CA125 – If >35 IU/ml, do a Pelvic US


Management

  • Urgently refer any woman with ascites and/or an unexplained pelvic/abdominal mass

  • Surgery +/- Chemotherapy



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