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Learn about ovarian cancer diagnosis, from clinical evaluation to imaging and surgery. Explore risk factors, symptoms, and diagnostic modalities. Understand the importance of early detection for better outcomes.
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Ovarian Cancer-Route to Diagnosis Waseem Kamran Consultant Gynaecological Oncologist St James’s Hospital Beacon hospital
Facts • Second most common cancer of female reproductive organs. • Average age of diagnosis is sixth decade • Life time risk is 1.4% • Epithelial ovarian cancer is the most common type
Diagnosis • Clinical • Biochemical • Imaging • Biopsy • Surgery
Clinical-I • Risk Factors • Caucasian origin. • Never being pregnant • Early age of menarche and late age of menopause. • Family history of ovarian cancer • Germline mutation-BRCA-I & BRCA-II • Lynch syndrome • 60% risk of endometrial cancer • 10-12% risk of ovarian cancer
Clinical-II • Signs and symptoms • No particular symptoms in early stage cancer • Often vague and ill-defined • Bloating, abdominal discomfort, feeling full • Urinary symptoms-Urgency and frequency • May mimic GI symptoms • Back pain, respiratory symptoms in advanced stage cancer.
Clinical-III • General Examination • Ascites • Abdominal mass • Lymph adenopathy • Pleural effusion • Pelvic Examination • Mass in POD • Fixed uterus • PR Examination
CA125 not very helpful in early stage cancer Can be normal in 50% of stage I ovarian cancer.
HE4 • Human Epididymis secretary protein • Used as Risk of Ovarian Malignancy Algorithm (ROMA) • Initial reports showed positive results • Does not contribute positively in the diagnosis of ovarian cancer* • May have a role in diagnosing persistent disease following cytoreductive surgery** *British Journal of Cancer (2011) 104, 863 – 870. doi:10.1038/sj.bjc.6606092 www.bjcancer.com Published online 8 February 2011 & 2011 Cancer Research UK **The Clearance of Serum Human Epididymis Protein 4 Following Primary Cytoreductive Surgery for Ovarian Carcinoma. Thompson C1, Kamran W1, Dockrell L1, Khalid S1, Kumari M2, Ibrahim N2, OʼLeary J3, Norris L2, Petzold M4, OʼToole S2, Gleeson N. Int J Gynecol Cancer. 2018 Jul;28(6):1066-1072. doi: 10.1097/IGC.0000000000001267
Imaging • Ultrasound scan • Abdominal • Trans-vaginal • CT scan • MRI
Imaging-I • Asymptomatic patients with adnexal pathology • Ultrasound-IOTA consortium • Pattern recognition • 95% sen, 91%spec
Imaging-II • IOTA-LR2 model
Imaging-III • CT scan • CT TAP • PET CT • MRI
Biopsy • Not recommended • Early cancers • Confined pathology • Metastatic/Advanced malignancy • Epithelial carcinoma • Germ cell tumours • Sex cord stromal • Recurrence
Surgery-I • Laparoscopy • No obvious disease. • Evaluate abdominal cavity • Biopsy • Staging surgery in early stage cancer.
Surgery-II • Laparotomy • Surgical Staging in advanced malignancy • Cytoreduction
Summery • Clinical Examination • Early stage • TVUS, then CT TAP/MRI • Advanced stage • CT • MRI • Tissue diagnosis • None of the imaging techniques can replace surgical evaluation