Ovarian Cancer, Mr Fateh Ghazel
Transcript of Ovarian Cancer, Mr Fateh Ghazel
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Walsall Healthcare NHS Trust
Ovarian Cancer
Fateh GhazalConsultant Obstetrician & Gynaecologist
23/3/16
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Outline• Background
• Primary care pathway
• Secondary care pathway
• ROCkeTS Study & IOTA rules
• Case presentations
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Background• 1 in 10 women will have surgery for ovarian mass
• 1 in 10 of suspected ovarian masses are non ovarian
• Incidence of malignancy in symptomatic ovarian masses is:
• 1:1000 for premenopausal women • 3:1000 for 50 years old
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Ovarian Cancer Spread• lifetime risk 2%
• Approximately 7000 women diagnosed in the UK each year
• Frequently diagnosed at Stage 3C/4
• Insidious onset with bloating and ascites
• Treated primarily with surgery and chemotherapy
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Ovarian cancer• Symptoms & Signs:
– Persistent (>12 times a month)• Bloating• Feeling full• Pelvic pain• Urinary urgency / frequency
– >50 & newly diagnosed IBS
1 in 2 women, aged 45 -70 present to GP each year with symptoms,
Sasieini BMC 2014
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Primary care investigations
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Non-malignant disorders
Pelvic-mass associated
Multi-visceral tuberculosis
Meigs and pseudo-Meigs syndrome
Ovarian hyperstimulation syndrome
Non-pelvic mass associated
Liver cirrhosis
Tuberculosis peritonitis
Uraemia and renal failure
Nephrotic syndrome
Fulminant hepatic failure
Pancreatitis
Malignant disorders
Primary pelvic tumour
Ovarian cancer
Advanced uterine cancer
Advanced fallopian-tube cancer
Advanced rectal or bladder cancer
Secondary pelvic involvement
Lymphoma with peritoneal involvement
Pancreatic carcinoma
Breast cancer with peritoneal metastasis
Gastric cancer with peritoneal metastasis/ Advanced hepatocellular ca
Raised CA125
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Internal auditGP referrals
CA125: 3:8 patients (37%)
USS: requested in 10:10 patients (100%)
USS images uploaded to fusion: 6:10 patients (60%)
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First treatment (≤ 31 days)
Referral To Treatment (≤ 62 days)
Two week wait (≤ 14 days)
Diagnosis communicated
to patient
Cancer Treatment
Period Start date (Decision To
Treat)
Treatment Start Date
Cancer Referral to Treatment start date
Date first seen
Current system
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Diagnosis communicated
to patient
Cancer Treatment
Period Start date (Decision To
Treat)
Treatment Start Date
Cancer Referral to Treatment start date
First treatment (≤ 31 days)
Referral To Treatment (≤ 62 days)
Four weeks (28 days)
Date first seen
Two week wait <14 days
New system
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Pre menopausal – Simple cyst
Asymptomatic patient
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Pre menopausal – Complex cyst
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Post menopausal – Ovarian cyst
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Post menopausal – Ovarian cyst
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RMI = U x M x CA-125• USS features:
• multilocular • solid areas• metastases • ascites• bilateral lesions
– U = 0 (for an ultrasound score of 0), – U = 1 (for an ultrasound score of 1), – U = 3 (for an ultrasound score of 2–5).
• The menopausal status is scored as – 1 = premenopausal – 3 = postmenopausal
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ROCkeTS Study & IOTA Rules• Multicentre• Portfolio Study – NIHR• 2 years period• Both pre and postmenopausal women with suspected ovarian
cancer• Exclusion simple ovarian cyst < 5 cm• No change in current management• Eligible patients will be invited for 3 extra tests
– Symptoms Questionnaire– Blood Test– Detailed TA/TV scan IOTA rules
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B-rules M-rules
Unilocular cysts Irregular solid tumour
Solid components <7mm Ascites
Acoustic shadowing At least four papillary structures
Smooth multilocular <100mm
Irregular multilocular solid tumour >100mm
No blood flow Very strong blood flow
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In conclusion• Ovarian cancer:
• 80% present at advanced stage • All stage 5 years survival <45%• The most common cause of gynaecological cancer death
• Suspect early, Investigate appropriately, Refer promptly
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Thank you for listening,any questions?