1. Malcolm Padwick MD FRCOG Gynaecology Cancer Surgeon
gynaecology.me.uk
Malcolm Padwick MD FRCOG Gynaecology Cancer Surgeon
Ovarian cancer

2. Overview 6900 cases per year in UK 1 in 75 women
5th 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 ...
25 Feb 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 Sues-horrifying-story-shows-bad-doctors-STILL- spotting-silent-killer.html - Similar

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. 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.

7. 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.

8. 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

9. 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

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

11. prognosis Survival rate by Stage 1 90% 2 60% to 70% 3 15% to 35%%
% to 70%
% to 35%
% to 15%
Latest data shows 50 % women alive at 5 yrs with stage 3 or 4 disease

12. 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

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

14. 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

15. 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

16. 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 ?

17. BSO can be day surgery

18. 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

19. news
Do not use Ca125 for follow up patients

20. news
HRT increases risk of epithelial ovarian cancer

21. news
Delayed surgery now accepted

22. news
Intraperitoneal chemotherapy

23. 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.

24. news Ultra radical cyto-reductive surgery Diaphragmatic stripping
Liver resection
Splenectomy
Coeliac axis lymph node dissection

25. 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