ovarian cancer, mr fateh ghazel
TRANSCRIPT
Walsall Healthcare NHS Trust
Ovarian Cancer
Fateh GhazalConsultant Obstetrician & Gynaecologist
23/3/16
Outline• Background
• Primary care pathway
• Secondary care pathway
• ROCkeTS Study & IOTA rules
• Case presentations
Background• 1 in 10 women will have surgery for ovarian mass
• 1 in 10 of suspected ovarian masses are non ovarian
• Incidence of malignancy in symptomatic ovarian masses is:
• 1:1000 for premenopausal women • 3:1000 for 50 years old
Ovarian Cancer Spread• lifetime risk 2%
• Approximately 7000 women diagnosed in the UK each year
• Frequently diagnosed at Stage 3C/4
• Insidious onset with bloating and ascites
• Treated primarily with surgery and chemotherapy
Ovarian cancer• Symptoms & Signs:
– Persistent (>12 times a month)• Bloating• Feeling full• Pelvic pain• Urinary urgency / frequency
– >50 & newly diagnosed IBS
1 in 2 women, aged 45 -70 present to GP each year with symptoms,
Sasieini BMC 2014
Primary care investigations
Non-malignant disorders
Pelvic-mass associated
Multi-visceral tuberculosis
Meigs and pseudo-Meigs syndrome
Ovarian hyperstimulation syndrome
Non-pelvic mass associated
Liver cirrhosis
Tuberculosis peritonitis
Uraemia and renal failure
Nephrotic syndrome
Fulminant hepatic failure
Pancreatitis
Malignant disorders
Primary pelvic tumour
Ovarian cancer
Advanced uterine cancer
Advanced fallopian-tube cancer
Advanced rectal or bladder cancer
Secondary pelvic involvement
Lymphoma with peritoneal involvement
Pancreatic carcinoma
Breast cancer with peritoneal metastasis
Gastric cancer with peritoneal metastasis/ Advanced hepatocellular ca
Raised CA125
Internal auditGP referrals
CA125: 3:8 patients (37%)
USS: requested in 10:10 patients (100%)
USS images uploaded to fusion: 6:10 patients (60%)
First treatment (≤ 31 days)
Referral To Treatment (≤ 62 days)
Two week wait (≤ 14 days)
Diagnosis communicated
to patient
Cancer Treatment
Period Start date (Decision To
Treat)
Treatment Start Date
Cancer Referral to Treatment start date
Date first seen
Current system
Diagnosis communicated
to patient
Cancer Treatment
Period Start date (Decision To
Treat)
Treatment Start Date
Cancer Referral to Treatment start date
First treatment (≤ 31 days)
Referral To Treatment (≤ 62 days)
Four weeks (28 days)
Date first seen
Two week wait <14 days
New system
Pre menopausal – Simple cyst
Asymptomatic patient
Pre menopausal – Complex cyst
Post menopausal – Ovarian cyst
Post menopausal – Ovarian cyst
RMI = U x M x CA-125• USS features:
• multilocular • solid areas• metastases • ascites• bilateral lesions
– U = 0 (for an ultrasound score of 0), – U = 1 (for an ultrasound score of 1), – U = 3 (for an ultrasound score of 2–5).
• The menopausal status is scored as – 1 = premenopausal – 3 = postmenopausal
ROCkeTS Study & IOTA Rules• Multicentre• Portfolio Study – NIHR• 2 years period• Both pre and postmenopausal women with suspected ovarian
cancer• Exclusion simple ovarian cyst < 5 cm• No change in current management• Eligible patients will be invited for 3 extra tests
– Symptoms Questionnaire– Blood Test– Detailed TA/TV scan IOTA rules
B-rules M-rules
Unilocular cysts Irregular solid tumour
Solid components <7mm Ascites
Acoustic shadowing At least four papillary structures
Smooth multilocular <100mm
Irregular multilocular solid tumour >100mm
No blood flow Very strong blood flow
In conclusion• Ovarian cancer:
• 80% present at advanced stage • All stage 5 years survival <45%• The most common cause of gynaecological cancer death
• Suspect early, Investigate appropriately, Refer promptly
Thank you for listening,any questions?