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Q1: Presentation (2 min)
"How does ovarian cancer typically present?"
- Silent killer — non-specific late symptoms
- Abdominal bloating/distension (most common)
- Early satiety, urinary frequency, pelvic pain
- Ascites, omental cake, weight loss (advanced)
- Most present Stage III/IV
Q2: Investigation (2 min)
"How do you investigate a suspected ovarian mass?"
- CA-125 (tumour marker — non-specific)
- Pelvic ultrasound (IOTA simple rules — characterise mass)
- RMI (Risk of Malignancy Index) — US + menopausal status + CA-125
- CT abdomen/pelvis (staging — peritoneal deposits, nodes, mets)
- CT output: omental cake, ascites, peritoneal seeding
Q3: Surgery (3 min)
"Describe the staging surgery for ovarian cancer."
- TAH + BSO + omentectomy + peritoneal biopsies ± lymph nodes
- Goal: OPTIMAL DEBULKING (residual under 1cm)
- Most important surgical factor for survival
- Neoadjuvant chemo → interval debulking if unresectable
Q4: BRCA (2 min)
"What is the BRCA association with ovarian cancer?"
- BRCA1: 40% lifetime risk. BRCA2: 20%
- BRCA involved in DNA repair (homologous recombination)
- Prophylactic BSO after family completion (age 35 to 45)
- PARP inhibitors (olaparib) for BRCA-mutated tumours
- Family screening important