1. Ovarian cancer  Malcolm Padwick MD FRCOG Gynaecology Cancer Surgeon

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

3. Google top hit today  Cancer missed 20 times: Sue's horrifying story shows how bad... 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 - SimilarSimilar

5. 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

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

7. prognosis  Stage Five-year survival rate  1 90%  2 60% to 70%  3 15% to 35%  4 5% to 15%

8. 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

9. Screening USS  Vaginal ultrasound  Accurate but high rate of false positives  Relatively expensive

10. 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 prophylactive surgery

11. 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

12. 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 ?

13. BSO can be day surgery

14. 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

15. news  Do not use Ca125 for follow up patients

16. news  HRT increases risk of epithelial ovarian cancer

17. news  Delayed surgery now accepted

18. news  Intraperitoneal chemotherapy

19. 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.

20. The message  Treatment is effective but only if we can catch the disease early enough