AKT revision: Ovarian cysts and cancer

1.Which one of the following statements is true about CA125?

A serum level greater than 100U/ml (NR <35 U/ml) makes a germ cell tumour the most likely diagnosis.
It is only raised if an epithelial ovarian tumour is present
It is an important parameter in the ovarian risk of malignancy index
The level is reduced if the patient has glycosuria
Women over 50 are screened with a serum CA125 every five years

Answer: C

The RMI combines Ultrasound findings, CA125 and menopausal status. CA125 is a non specific test and the most likely association is with epithelial tumours and not germ cell. Other tumours may cause it to be raised as may diabetes, CCF and liver disease

*The options below relate to referral patterns in women with issues relating to potential ovarian pathology. Each option may be used once, more than once or not at all. Indicate the single most appropriate answer for each patient.

2.A 56 year old woman complaining of bloating and a walnut sized adnexal swelling

A. Initial management in primary care
B. Routine referral
C. Two week referral
D. Urgent admission

Answer: C

3. A 30 year old asymptomatic Irish woman whose sister has breast cancer aged 35

A. Initial management in primary care
B. Routine referral
C. Two week referral
D. Urgent admission

Answer: B

for genetic counselling / testing.

4. A 3.5cm right sided cyst found on pelvic ultrasound in a 28 year old non pregnant woman

A. Initial management in primary care
B. Routine referral
C. Two week referral
D. Urgent admission

Answer: A

referral will however be necessary if this is still present on a repeat scan in 2-3 months.

5. A 40 year old asymptomatic Jewish woman whose aunt died from ovarian cancer

A. Initial management in primary care
B. Routine referral
C. Two week referral
D. Urgent admission

Answer: B

for genetic counselling / testing since there is a higher incidence of BRCA1 and BRCA2 mutations in this population.