Makindo Medical Notes

📖 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)

💊 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.