Download Ovarian cancer - Malcolm Padwick MD, FRCOG

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 Malcolm Padwick MD FRCOG
Gynaecology Cancer Surgeon
Ovarian cancer
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-timesSues-horrifying-story-shows-bad-doctors-STILLspotting-silent-killer.html - Similar
symptoms
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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 appetite
Pelvic or abdominal pain
Increased urinary frequency and/or urgency
Unexplained weight loss fatigue or change in
bowel habit
Women over 50 yrs with new diagnosis of IBS
NICE guidelines 2011
Primary care : First tests
Serum CA125
If CA125 > 35 IU/ml
Pelvic 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
 2
 3
 4
90%
60% to 70%
15% to 35%
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 stripping
Liver resection
Splenectomy
Coeliac 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