OG34.2 | Ovarian Cancer — Summary & Reflection

KEY TAKEAWAYS

Ovarian cancer is the most lethal gynaecological malignancy because it presents at an advanced stage in the majority of patients. Key learning points: (1) The three histological groups — epithelial (~90%), germ cell (~5%), sex-cord stromal (~5%) — have distinct biology, age distribution, tumour markers, and management. (2) The FIGO 2014 ovarian cancer staging system is surgical and unique to this organ system; Stages III–IV carry a 5-year survival of 20–40%. (3) Risk stratification of an adnexal mass uses the RMI (menopausal status × ultrasound score × CA-125); RMI >200 = refer to gynaecological oncology centre. (4) Tumour markers must match histotype: CA-125 for epithelial, AFP+β-hCG+LDH for germ cell, inhibin for granulosa cell. (5) Surgery (staging laparotomy: TAH+BSO+omentectomy+node dissection+washings) both stages and debulks; optimal cytoreduction (<1 cm residual) improves survival. (6) First-line chemotherapy for epithelial: carboplatin+paclitaxel ×6 cycles; BEP for germ cell; PARP inhibitor maintenance for BRCA-mutated advanced disease. (7) Surveillance uses serial CA-125 and CT; treat rising CA-125 with CT/clinical review, not immediate chemotherapy. (8) Genetic counselling with BRCA1/2 testing for all epithelial ovarian cancer patients.

REFLECT

Reflect on a case or scenario where a delay in diagnosis of ovarian cancer occurred. What symptoms were initially attributed to benign causes? What investigations, if ordered earlier, might have changed the course? How would you now approach a postmenopausal woman presenting with vague abdominal discomfort and bloating in the outpatient clinic — what specific questions, examination, and initial investigations form your minimum workup? Think about how you would communicate the finding of an elevated CA-125 and a complex ovarian mass to a patient, balancing the urgency of further investigation with avoiding premature distress before a histological diagnosis is established.