Ovarian Cancer for PA
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Ovarian Cancer for the Physician Assistant Licensing Exam
- Epidemiology:
- Ovarian cancer is a leading cause of death from gynecologic cancers, often diagnosed at advanced stages due to nonspecific early symptoms.
- Risk Factors:
- Postmenopausal age, family history of ovarian or breast cancer, BRCA1 and BRCA2 mutations.
- Increased lifetime ovulatory cycles (e.g., early menarche, late menopause, nulliparity).
- Protective Factors:
- Oral contraceptive use, pregnancy, and breastfeeding reduce risk by lowering the number of ovulatory cycles.
Types of Ovarian Cancer
- Epithelial Tumors:
- Comprise approximately 90% of ovarian cancers.
- Serous Carcinomas: Most common, aggressive, often diagnosed at later stages.
- Mucinous Carcinomas: Less common; can grow large and may cause abdominal distension.
- Endometrioid and Clear Cell Carcinomas: Linked to endometriosis.
- Germ Cell Tumors:
- Occur more commonly in younger women and include dysgerminomas, yolk sac tumors, and teratomas. Generally chemosensitive with a favorable prognosis.
- Sex Cord-Stromal Tumors:
- Can produce hormones, with granulosa cell tumors causing estrogen-related symptoms like endometrial hyperplasia, and Sertoli-Leydig cell tumors causing androgenic effects.
Clinical Presentation
- Symptoms:
- Often asymptomatic in early stages. Common symptoms include:
- Abdominal bloating, pelvic pain, early satiety, urinary urgency or frequency.
- Advanced Disease: May present with ascites, bowel obstruction, or pleural effusion.
Diagnosis
- Imaging:
- Pelvic Ultrasound: First-line imaging. Suspicious findings include thick septations, solid areas, and ascites.
- CT Scan: Used for staging and evaluating metastasis.
- Laboratory Tests:
- CA-125: Tumor marker elevated in most epithelial ovarian cancers, though nonspecific.
- AFP, hCG, and LDH: Useful for identifying specific germ cell tumors.
Treatment
- Surgical Treatment:
- Debulking Surgery: Standard for advanced disease, aiming to remove all visible tumor tissue.
- Fertility-Sparing Surgery: An option for young patients with early-stage disease.
- Chemotherapy:
- Platinum-Based Chemotherapy: Used in most cases, typically carboplatin and paclitaxel.
- Targeted Therapy:
- PARP Inhibitors for BRCA-mutated ovarian cancer, and Bevacizumab for advanced disease to inhibit tumor blood supply.
Key Points
- Ovarian Cancer is often detected late due to vague symptoms; epithelial tumors are the most common.
- Risk Factors include age, genetic mutations, and increased ovulatory cycles, while oral contraceptives and pregnancy are protective.
- Diagnosis involves ultrasound and CA-125, with definitive confirmation via histopathology.
- Treatment includes debulking surgery and chemotherapy, with targeted therapies like PARP inhibitors for BRCA-positive cases.