Ovarian cancer

Malcolm Padwick MD FRCOG Gynaecology Cancer Surgeon

gynaecology.me.uk

Overview

6900 cases per year in UK 1 in 75 women 5th most common cancer in women Half are over 65 75% mortality

Google top hit today

Cancer missed 20 times: Sue's horrifying story shows how bad ...

25 Feb 2009 ... While this may sound like an horrific one-off, Sue's story is far from unique. The charity Target Ovarian Cancer, which has just committed ...www.dailymail.co.uk/.../Cancer-missed-20-times-Sues-horrifying-story-shows-bad-doctors-STILL-spotting-silent-killer.html - Similar

symptoms

Bloated abdomen Full after starting to eat Weight loss Nausea and indigestion Pelvic pain Change in bowel habit Frequency of urine Backache Swollen ankles Abdominal mass Vaginal bleeding

NICE guidelines 2011

Primary care : 2 week wait referral if physical examination identifies ascites and/or pelvic mass not caused by known fibroids.

No need to wait for investigations.

NICE guidelines 2011

Primary care : investigate women, especially if over 50 yrs, if they report any of the following symptoms on a persistent or frequent basis.

NICE guidelines 2011

Persistent abdominal distention (bloating)Feeling full – early satiety and/or loss of appetitePelvic or abdominal painIncreased urinary frequency and/or urgencyUnexplained weight loss fatigue or change in bowel habitWomen over 50 yrs with new diagnosis of IBS

NICE guidelines 2011

Primary care : First tests

Serum CA125

If CA125 > 35 IU/mlPelvic and abdominal ultrasound

If CA125 or USS negative investigate for other causes and ask patient to return if symptoms become more frequent or persistent

misdiagnosis

Gastric or peptic ulcers (GI referral) Gallstones (surgeons) Diverticulitis (colorectal) Cystitis (urology) SOB pleural effusion/ PE (chest

physician)

prognosis

Survival rate by Stage 1 90% 2 60% to 70% 3 15% to 35% 4 5% to 15%

Latest data shows 50 % women alive at 5 yrs with stage 3 or 4 disease

Screening Ca125

85% of women with cancer have a raised CA125

But only 50% of women with early stage cancer have a raised CA125

Ca125 is raised in benign conditions

Screening USS

Vaginal ultrasound Accurate but high rate of false

positives Relatively expensive

screening

No general screening available in UK Selective screening for high risk

individuals – more than two affected direct relatives

BRAC 1 and 2 High risk screening not officially

recommended but has acceptance Consider preventative surgery

Making a diagnosis

New symptoms in otherwise fit women

Postmenopausal – especially > 65 yrs

A large mass in a woman with minimal or new symptoms is likely to be ovary/uterus

New diagnosis of IBS after 40 yrs is rarely correct !

USS is single most useful investigation

USS

Good quality community based service ??

Wait to select correct specialty service – getting this wrong can generate major delays

What is the danger in finding coincidental benign disease ?

BSO can be day surgery

Ovplex

362 plasma samples from women with ovarian cancer (n=150) and healthy controls (n=212) were used to develop a multivariate classification model incorporating five plasma biomarkers associated with ovarian cancer. Based upon the measurement of these 5 markers, the model calculates the likelihood that a patient has ovarian cancer

news

Do not use Ca125 for follow up patients

news

HRT increases risk of epithelial ovarian cancer

news

Delayed surgery now accepted

news

Intraperitoneal chemotherapy

news

Science News Personalized Treatment for Ovarian Cancer ScienceDaily (Nov. 17, 2010) — Researchers have

shown that point mutations -- mis-spellings in a single letter of genetic code -- that drive the onset and growth of cancer cells can be detected successfully in advanced ovarian cancer using a technique called OncoMap. The finding opens the way for personalised medicine in which every patient could have their tumour screened, specific mutations identified, and the appropriate drug chosen to target the mutation and halt the growth of their cancer.

news

Ultra radical cyto-reductive surgery

Diaphragmatic strippingLiver resectionSplenectomyCoeliac axis lymph node dissection

The message

Treatment is effective but only if we can catch the disease early enough

Treatment is more about living a good quality of life with the disease rather than cure