Background information

Question 1

Risk Factors

Answer 1

Age, caucasian, increased # of ovulations- early menarche, late menopause, nulliparity or first birth >35 years, Lynch syndrome, BRCA 1/2

Question 2

Favorable Prognosis

Answer 2

Stage IA or IB, grade 1- surgery only 
First birth/delivery < 25 years of age
Use of oral contraceptives
History of breast feeding
Tubal ligation
Age < 65 years of age at diagnosis
Good performance status

Question 3

Poor Prognosis

Answer 3

Stage IC and up; Stage II with ascites, ruptured capsule, or clear cell histology
70% of patients present in Stage III or IV. 
Nulliparity or >35
Early menarche, late menopause
PCOS
Family hx
Personal h/o breast CA
Ashkenazi Jewish 
BRCA1/2, HNPCC

Question 4

Screening

Answer 4

NOT recommended unless high risk patient.
High risk: pelvic exam, transvaginal ultrasound, CA-125 q 6-12 months beginning age 25-35.
CA-125 correlated with disease extent. False (+) in premenopausal women, endometriosis, benign disease.

Question 5

Pathology

Answer 5

Epithelial ovarian cancer 90%- serous most common 50%

Stromal and germ cell tumors 10%

Question 6

Signs and symptoms of advanced disease

Answer 6

Bloating, early satiety, low back pain, GI upset/pain, pain after intercourse, CA-125 levels >35 ug/mL

Question 7

FIGO Staging Surgery (ALL patients)

Answer 7

1: Ovary involvement only–> surgery + chemo if high grade
2. Spread out of ovaries into pelvis–> surgery + chemo
3. Spread into abdomen or lymph node –> surgery + chemo
4. M1–> surgery + chemo

Question 8

TAH

Answer 8

Total abdominal hysterectomy

Question 9

BSO

Answer 9

Bilateral salpingo-oophorectomy

Question 10

USO

Answer 10

Unilateral salpingo-oophorectomy

Question 11

Lynch (II) or BRCA1/2

Answer 11

Prophylactic oophorectomy after childbearing complete; not protective against primary peritoneal carcinoma