3 - Ovarian Neoplasms Flashcards
first step in evaluating adnexal masses
always rule out pregnancy and infection first
characteristics of malignant ovarian masses
large, bilateral, solid (instead of cystic), complex, papillary, inc density, dec pulsatility of blood flow, non-reproductive age, ascites, elevated serum tumor markers
CA125 - what cancer is it used to monitor? what else could it indicate?
ovarian
not specific - higher in anything that irritates peritoneal membrane
size cutoff for ovarian masses becoming suspicious in reproductive age woman
10 cm
MC cystic ovarian mass in repro age women
functional/follicular cyst
ovarian fibroma (thecoma) - what is it composed of, who gets it
spindle cells and fibrous bands
more common in older women
general risk of developing ovarian CA
1.8%
risk factors for ovarian CA
age (56-60 is peak) family hx (triples risk) BRCA never pregnant incessant ovulation hx of endometriosis
clinical features of ovarian CA
abdom distension ascites abd pain/discomfort bowel obstruction N/V altered bowel habits urinary freq/retention bloating early satiety
3 cell types of ovarian CA and which is most common
surface epithelium-stroma - 95% of cases
germ cells
sex cord-stroma
germ cell ovarian CA - who gets it, outlook
10-30 yo
very chemosensitive - better than epithelial
tumor markers for germ cell tumors
LDH, HCG, AFP
stromal cell ovarian CA - who gets it, presentation, specific tumor
any age, but more common in younger women
precocious puberty, hyperandrogenism, pelvic mass/pain
granulosa cell tumors
tumor marker for granulosa cell tumor of ovary
inhibin
Call-Exner bodies
hallmark path finding for granulosa cell tumors of ovary - sorta rings of cells surrounding eosinophilic material
which type of ovarian CA secretes estrogen and thus increases risk for uterine CA in postmenopausal women?
granulosa cell tumor
2 MC metastases to ovary
1 - colon
2 - breast
tx for ovarian CA
surgery - hysterectomy, tumor debulking as much as possible
chemo - neoadjuvant or adjunct. taxanes and platinums are best
radiation has a limited role
staging of ovarian CA
1 - ovary only
2 - adnexa/uterus
3 - peritoneal spread
4 - distant mets - liver/lungs
2 hereditary causes of ovarian CA
lynch syndrome (HNPCC) Hereditary breast-ovarian CA syndrome - BRCA
which BRCA has more ovarian CA?
BRCA1
mechanism of BRCA ovarian CA
BRCA regulates p53
loss of BRCA > loss of p53 control of cell cycle
who should be BRCA tested?
family or personal hx of breast CA < 50 yo
family or personal hx of ovarian CA
male breast CA
screening for ovarian CA
no recommended screening tool - some success with Risk of Ovarian Cancer Algorithm (ROCA), but that is just now coming out
BRCA cancer screening
CA125 w/ pelvic US btwn 30-35 yo or 5-10 yrs before earliest dx in family
clinical breast exam 2x/yr, annual mammogram and MRI at 25 or sooner based on earliest dx in family
