🔑 Key Learning

  • 90% of ovarian cancers are epithelial in origin, most commonly serous carcinomas.
  • Presents late due to vague symptoms:  Always consider ovarian cancer in women > 50 with new-onset bloating, satiety or pelvic symptoms.
  • 1st line investigation: CA125
    • If CA125 > 35 - urgent transvaginal pelvic ultrasound

🧬 Pathophysiology

  • 90% of ovarian tumours are epithelial carcinomas.
    • Of these, 80% are serous carcinomas.
  • Risk factors:
    • Early menarche
    • Late menopause
    • Nulliparity
    • Family history of ovarian or breast cancer
    • BRCA1 or BRCA2 mutations
    • Lynch syndrome

👀 Clinical Features

  • Typically affects women over 50 years.
  • Persistent and non-specific symptoms:
    • Abdominal distension or bloating
    • Early satiety or anorexia
    • Pelvic or abdominal pain
    • Urinary urgency or frequency
  • Examination findings:
    • Ascites
    • Pelvic or abdominal mass
  • Exclude ovarian cancer before diagnosing IBS or overactive bladder in women over 50!

🧪 Investigations

Initial assessment

  • If ascites or pelvic/abdominal mass is found → refer via 2-week wait (suspected cancer pathway).
  • If examination is normal:
    • 1st line: Measure serum CA125.
    • If CA125 > 35 U/mL → arrange urgent transvaginal and abdominal ultrasound.
      • If ultrasound findings suggest malignancy → urgent referral to gynaecology or specialist multidisciplinary team.

💊 Management

  • Primary treatment is surgical debulking.
  • May include total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy.
  • Adjuvant chemotherapy (e.g. carboplatin/paclitaxel) depending on stage.
  • CA125 used for monitoring treatment response and recurrence.

📝 Exam Clues & Clinchers

  • Postmenopausal woman with new bloating and early satiety.
  • CA125 > 35 → urgent ultrasound.
  • Refer via 2WW if ascites or mass present.

🔗 Useful Links and References

NICE CKS. Ovarian cancer [July 2018]. Available at: https://cks.nice.org.uk/topics/ovarian-cancer/