ovarian cancer malcolm padwick md frcog gynaecology cancer surgeon gynaecology.me.uk
TRANSCRIPT
Ovarian cancer
Malcolm Padwick MD FRCOG Gynaecology Cancer Surgeon
gynaecology.me.uk
Overview
6900 cases per year in UK 1 in 75 women 5th most common cancer in women Half are over 65 75% mortality
Google top hit today
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 - Similar
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
NICE guidelines 2011
Primary care : 2 week wait referral if physical examination identifies ascites and/or pelvic mass not caused by known fibroids.
No need to wait for investigations.
NICE guidelines 2011
Primary care : investigate women, especially if over 50 yrs, if they report any of the following symptoms on a persistent or frequent basis.
NICE guidelines 2011
Persistent abdominal distention (bloating)Feeling full – early satiety and/or loss of appetitePelvic or abdominal painIncreased urinary frequency and/or urgencyUnexplained weight loss fatigue or change in bowel habitWomen over 50 yrs with new diagnosis of IBS
NICE guidelines 2011
Primary care : First tests
Serum CA125
If CA125 > 35 IU/mlPelvic and abdominal ultrasound
If CA125 or USS negative investigate for other causes and ask patient to return if symptoms become more frequent or persistent
misdiagnosis
Gastric or peptic ulcers (GI referral) Gallstones (surgeons) Diverticulitis (colorectal) Cystitis (urology) SOB pleural effusion/ PE (chest
physician)
prognosis
Survival rate by Stage 1 90% 2 60% to 70% 3 15% to 35% 4 5% to 15%
Latest data shows 50 % women alive at 5 yrs with stage 3 or 4 disease
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
Screening USS
Vaginal ultrasound Accurate but high rate of false
positives Relatively expensive
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 preventative surgery
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
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 ?
BSO can be day surgery
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
news
Do not use Ca125 for follow up patients
news
HRT increases risk of epithelial ovarian cancer
news
Delayed surgery now accepted
news
Intraperitoneal chemotherapy
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.
news
Ultra radical cyto-reductive surgery
Diaphragmatic strippingLiver resectionSplenectomyCoeliac axis lymph node dissection
The message
Treatment is effective but only if we can catch the disease early enough
Treatment is more about living a good quality of life with the disease rather than cure