3 - Ovarian Neoplasms

Question 1

first step in evaluating adnexal masses

Answer 1

always rule out pregnancy and infection first

Question 2

characteristics of malignant ovarian masses

Answer 2

large, bilateral, solid (instead of cystic), complex, papillary, inc density, dec pulsatility of blood flow, non-reproductive age, ascites, elevated serum tumor markers

Question 3

CA125 - what cancer is it used to monitor? what else could it indicate?

Answer 3

ovarian

not specific - higher in anything that irritates peritoneal membrane

Question 4

size cutoff for ovarian masses becoming suspicious in reproductive age woman

Answer 4

10 cm

Question 5

MC cystic ovarian mass in repro age women

Answer 5

functional/follicular cyst

Question 6

ovarian fibroma (thecoma) - what is it composed of, who gets it

Answer 6

spindle cells and fibrous bands

more common in older women

Question 7

general risk of developing ovarian CA

Answer 7

1.8%

Question 8

risk factors for ovarian CA

Answer 8

age (56-60 is peak)
family hx (triples risk)
BRCA
never pregnant
incessant ovulation
hx of endometriosis

Question 9

clinical features of ovarian CA

Answer 9

abdom distension
ascites
abd pain/discomfort
bowel obstruction
N/V
altered bowel habits
urinary freq/retention
bloating
early satiety

Question 10

3 cell types of ovarian CA and which is most common

Answer 10

surface epithelium-stroma - 95% of cases
germ cells
sex cord-stroma

Question 11

germ cell ovarian CA - who gets it, outlook

Answer 11

10-30 yo

very chemosensitive - better than epithelial

Question 12

tumor markers for germ cell tumors

Answer 12

LDH, HCG, AFP

Question 13

stromal cell ovarian CA - who gets it, presentation, specific tumor

Answer 13

any age, but more common in younger women
precocious puberty, hyperandrogenism, pelvic mass/pain
granulosa cell tumors

Question 14

tumor marker for granulosa cell tumor of ovary

Answer 14

inhibin

Question 15

Call-Exner bodies

Answer 15

hallmark path finding for granulosa cell tumors of ovary - sorta rings of cells surrounding eosinophilic material

Question 16

which type of ovarian CA secretes estrogen and thus increases risk for uterine CA in postmenopausal women?

Answer 16

granulosa cell tumor

Question 17

2 MC metastases to ovary

Answer 17

1 - colon

2 - breast

Question 18

tx for ovarian CA

Answer 18

surgery - hysterectomy, tumor debulking as much as possible
chemo - neoadjuvant or adjunct. taxanes and platinums are best
radiation has a limited role

Question 19

staging of ovarian CA

Answer 19

1 - ovary only
2 - adnexa/uterus
3 - peritoneal spread
4 - distant mets - liver/lungs

Question 20

2 hereditary causes of ovarian CA

Answer 20

lynch syndrome (HNPCC)
Hereditary breast-ovarian CA syndrome - BRCA

Question 21

which BRCA has more ovarian CA?

Answer 21

BRCA1

Question 22

mechanism of BRCA ovarian CA

Answer 22

BRCA regulates p53

loss of BRCA > loss of p53 control of cell cycle

Question 23

who should be BRCA tested?

Answer 23

family or personal hx of breast CA < 50 yo
family or personal hx of ovarian CA
male breast CA

Question 24

screening for ovarian CA

Answer 24

no recommended screening tool - some success with Risk of Ovarian Cancer Algorithm (ROCA), but that is just now coming out

Question 25

BRCA cancer screening

Answer 25

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