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Ovarian Cancer-Route to Diagnosis

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%

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Ovarian Cancer-Route to Diagnosis

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  1. Ovarian Cancer-Route to Diagnosis Waseem Kamran Consultant Gynaecological Oncologist St James’s Hospital Beacon hospital

  2. 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

  3. Diagnosis • Clinical • Biochemical • Imaging • Biopsy • Surgery

  4. 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

  5. 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.

  6. Clinical-III • General Examination • Ascites • Abdominal mass • Lymph adenopathy • Pleural effusion • Pelvic Examination • Mass in POD • Fixed uterus • PR Examination

  7. Diagnostic modalities

  8. CA125 not very helpful in early stage cancer Can be normal in 50% of stage I ovarian cancer.

  9. 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

  10. Imaging • Ultrasound scan • Abdominal • Trans-vaginal • CT scan • MRI

  11. Imaging-I • Asymptomatic patients with adnexal pathology • Ultrasound-IOTA consortium • Pattern recognition • 95% sen, 91%spec

  12. Imaging-II • IOTA-LR2 model

  13. Imaging-III • CT scan • CT TAP • PET CT • MRI

  14. Biopsy • Not recommended • Early cancers • Confined pathology • Metastatic/Advanced malignancy • Epithelial carcinoma • Germ cell tumours • Sex cord stromal • Recurrence

  15. Surgery-I • Laparoscopy • No obvious disease. • Evaluate abdominal cavity • Biopsy • Staging surgery in early stage cancer.

  16. Surgery-II • Laparotomy • Surgical Staging in advanced malignancy • Cytoreduction

  17. 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

  18. Thank You

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