Ovarian Cancer
🧬 Ovarian cancer arises from the ovaries and is primarily classified into three groups: epithelial tumours, stromal tumours, and germ cell tumours.
🌸 Epithelial ovarian cancer (EOC) is the most common type, accounting for ~90% of cases.
⚠️ Pathogenesis often involves mutations in BRCA1, BRCA2, and tumour suppressor genes (e.g. p53).
It is often diagnosed late due to vague early symptoms, contributing to high mortality.
📖 About
- ⚠️ Ovarian cancer is the leading cause of gynaecological cancer death, ~8% of all female cancers.
- ⬇️ Incidence is reduced with long-term use of the contraceptive pill.
🔬 Aetiology / Risk Factors
- 👩👩👧 Family history of ovarian or breast cancer.
- 🧬 Inherited gene mutations (BRCA1/2, Lynch syndrome).
- 👵 Increasing age - most common in postmenopausal women.
- 👶 Reproductive history - nulliparity, infertility, early menarche, late menopause increase risk.
- 💊 Hormone replacement therapy (HRT).
- ⚖️ Obesity and endometriosis (weaker association).
🧩 Clinical Features
- 🌪️ Non-specific abdominal symptoms: bloating, distension, pelvic pain.
- 🚽 Urinary symptoms: urgency, frequency, incontinence.
- 🍽️ Early satiety, loss of appetite.
- ⚖️ Unexplained weight loss, fatigue, bowel habit changes.
- ⏱️ Diagnosis often delayed - many present at advanced stage.
🧾 Differential Diagnosis
- IBS (rare new-onset >50 yrs).
- Other pelvic masses (benign ovarian cysts, fibroids).
- GI malignancies (colon, stomach).
- Ascites from cirrhosis or heart failure.
🔎 Investigations
- 🧪 Bloods: FBC, ESR (anaemia), LFTs.
In women <40 yrs: also check AFP & β-hCG (exclude germ cell tumours).
Measure CA-125: if ≥35 IU/ml → arrange urgent pelvic & abdominal ultrasound.
- 👩⚕️ Pelvic Examination: First step in evaluating symptoms.
- 🖥️ Transvaginal ultrasound: Detects ovarian mass, solid/cystic changes.
- 🧬 CA-125: Raised in many EOC cases (false positives in menstruation, endometriosis).
- 🧲 CT/MRI: Staging, metastatic spread.
- 🔬 Histology: Definitive diagnosis from biopsy (or cytology if biopsy not feasible).
➡️ Always obtain tissue diagnosis before chemotherapy unless exceptional circumstances.
📊 FIGO Staging (International Federation of Gynaecology & Obstetrics)
| Stage |
Description |
| I | Cancer confined to one/both ovaries. |
| II | Spread to pelvis (uterus, tubes, bladder, rectum). |
| III | Spread within abdominal cavity ± retroperitoneal nodes. |
| IV | Distant metastasis (e.g. lung, liver parenchyma). |
💊 Management
- 🔪 Surgery: Staging laparotomy, total abdominal hysterectomy + bilateral salpingo-oophorectomy (TAH-BSO), and tumour debulking.
- 💉 Chemotherapy: Platinum-based regimens (carboplatin ± paclitaxel) are standard.
Given every 3 weeks for 6 cycles; weekly dosing protocols increasingly used for tolerance.
- 🎯 Targeted therapy: PARP inhibitors (e.g. olaparib) for BRCA mutation carriers; bevacizumab (anti-VEGF) in some advanced cases.
- ☢️ Radiotherapy: Rarely used, reserved for palliation of local disease.
- 🧪 Immunotherapy: Under research; checkpoint inhibitors being trialled.
⚠️ Key Clinical Notes
🔍 Ovarian cancer is called the “silent killer” due to vague early symptoms.
👩⚕️ NICE recommends urgent CA-125 and ultrasound for women ≥50 with persistent bloating, abdominal pain, or early satiety.
🧬 Genetic counselling and BRCA testing should be offered to women with strong family history.
