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 Pelvic Examination PR Examination
Ascites
Abdominal mass
Lymph adenopathy
Pleural effusion
Pelvic Examination
Mass in POD
Fixed uterus
PR Examination

7. Diagnostic modalities
Modality
Sensitivity
Specificity
Transvaginal ultrasonography
82-91%
68-81%
CT scan
86%
91%
MRI
90%
75%
PET CT
67%
79%
CA125
78%
92%
HE4
72%
95%

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: /sj.bjc 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): doi: /IGC

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 Metastatic/Advanced malignancy Recurrence
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 Advanced stage
TVUS, then CT TAP/MRI
Advanced stage CT
MRI
Tissue diagnosis
None of the imaging techniques can replace surgical evaluation

18. Thank You