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Ovarian cancer….. in 15 minutes

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Presentation on theme: "Ovarian cancer….. in 15 minutes"— Presentation transcript:

1 Ovarian cancer….. in 15 minutes
Robert Macdonald Consultant Gynaecological Oncologist Liverpool Womens Hospital

2 Overview Diagnosis Investigations Treatment Palliation Genetics

3 Diagnosis No gynae symptoms ! Bloating/ distension Bladder symptoms
Constant, not intermittent Bladder symptoms Increasing frequency Abdominal pain W Hamilton 2009 Nausea Early satiety Loss of appetite Bowel symptoms Change in bowel habit “IBS” IBS does not present in post menppausal women PV bleeding Breathlessness Cahexia Bowel obstruction

4 Investigations NICE Ca125 Ultrasound Secondary referral
If raised, then… Ultrasound If abnormal, then…. Secondary referral TVS CT Laparotomy Laparoscopy Biopsy and primary chemotherapy

5 However…. Ca125 Also increased with….. Not a good predictive test
Can be of limited value Premenopausal Raised with Endometriosis PID A period Post menopausal Not raised in 20% of ovarian cancers Mucinous tumours Also increased with….. Diverticular disease Appendicitis Cirrhosis Heart failure Cancer Bowel Pancreatic Breast

6 Pragmatic approach Examination Post menopausal woman
Obvious ascites Refer Post menopausal woman Raised Ca125 Refer if symptomatic Scan if asymptomatic Large mass even if Ca125 in normal Pre menopausal woman Borderline Ca125 (25-50) and normal scan Repeat Ca125 and review Normal Ca125 and small cyst (<5cm) on scan Repeat scan and review Raised Ca125 and abnormal scan Refer if not endometriosis If in doubt, ASK Gynae Oncology address for advice/ discussion

7 Treatment Primary Surgery Primary Chemotherapy If deemed resectable
Laparotomy TAH BSO Omentectomy Bowel resection Peritoneal stripping 3-5 days in hospital Chemotherapy If extensive disease/ unresectable CT guided biopsy/ laparoscopic biopsy 3 cycles chemotherapy MDT review Interval debulking surgery Completion of chemotherapy

8 New treatment Surgery Chemotherapy Increasingly radical surgery
More use of bowel resection Splenectomy Upper abdominal peritoneal resection Chemotherapy Anti angiogenic agents Bevacizumab Trials ICON 8 Weekly chemotherapy PETROC Intraperitoneal chemotherapy

9 Palliation 60-70% of patient die Long palliative phase Ascites Nausea
Pain Cahexia Bowel obstruction

10 Palliation Ascites Pain and nausea Bowel obstruction LWH
Day case paracentesis service Diuretics Pain and nausea CG 140 Opioid use in palliative care Early use of opiates Syringe driver Bowel obstruction Steroids Surgery LWH Mulberry Suite Orchid Suite Symptom control End of life care

11 Familial BRCA 1 and 2 HNPCC Historically Now gene testing
1-2% of ovarian cancer hereditary 15-40% lifetime risk of ovarian cancer Now gene testing 15-20% of high grade ovarian cancers carry BRCA gene defects It will change treatment and outcome Better outcome in BRCA +ve tumours PARP inhibitor due to be licensed 2015 Olaparib HNPCC Lynch syndrome MLH1 / MSH2 30% lifetime risk of ovarian cancer Commonest initial presentation in women Pre menopausal endometrial cancer 80% lifetime risk

12 Familial Screening Prophylactic surgery Not ideal High false positive
Transvaginal ultrasound Ca125 Annual High false positive Pre menopausal women Significant false negative No pre-malignant condition Natural history not well understood Fallopian tube cancer? Primary peritoneal cancer? Prophylactic surgery Laparoscopic BSO Laparoscopic bilateral salpingectomy Total laparoscopic hysterectomy BSO 24-36 hours in hospital

13 In conclusion Increasing incidence We need to increase awareness
Symptoms Treatment Family history Treatment progress Surgery Chemotherapy Genetics testing It WILL change treatment and patient expectation Familial cancer and screening Target Ovarian GP module

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