Ovarian cancer
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Transcript of Ovarian cancer
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Ovarian cancer
Malcolm Padwick MD FRCOG Gynaecology Cancer Surgeon
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Overview
6900 cases per year in UK 1 in 75 women 5th most common cancer in women Half are over 65 75% mortality
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Google top hit today
Cancer missed 20 times: Sue's horrifying story shows how bad ...
25 Feb 2009 ... 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 ...www.dailymail.co.uk/.../Cancer-missed-20-times-Sues-horrifying-story-shows-bad-doctors-STILL-spotting-silent-killer.html - Similar
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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
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misdiagnosis
Gastric or peptic ulcers (GI referral) Gallstones (surgeons) Diverticulitis (colorectal) Cystitis (urology) SOB pleural effusion/ PE (chest
physician)
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prognosis
Stage Five-year survival rate 1 90% 2 60% to 70% 3 15% to 35% 4 5% to 15%
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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
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Screening USS
Vaginal ultrasound Accurate but high rate of false
positives Relatively expensive
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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 prophylactive surgery
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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
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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 ?
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BSO can be day surgery
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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
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news
Do not use Ca125 for follow up patients
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news
HRT increases risk of epithelial ovarian cancer
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news
Delayed surgery now accepted
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news
Intraperitoneal chemotherapy
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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.
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The message
Treatment is effective but only if we can catch the disease early enough