Chapter 46

Question 1

How does a patient with Acites present?

Answer 1

Expanding abdominal girth for the past week and early satiety bloating anorexia. Smoker and drinker

Question 2

What is a differential diagnosis for a patient with ascites?

Answer 2

Cirrhosis, congestive heart failure, ovarian cancer

Question 3

What makes ovarian cancer more likely then the other causes of ascites?

Answer 3

Nulliparous post menopausal female with a few risk for cirrhosis and congestive heart failure

Question 4

What does a physical examination for ovarian cancer show?

Answer 4

Fixed right pelvic mass. Abdominal distention

Question 5

What is the preferred initial test? Showing what? What does CBC show? What is the diagnosis?

Answer 5

Pelvic ultrasound, Malignant appearing right ovarian mass with Peritoneal seeding and anemia; Metastatic ovarian cancer

Question 6

What can be used for a diagnostic, therapeutic and staging?

Answer 6

Surgical intervention

Question 7

What are the other cancers that are metastatic to the ovary?

Answer 7

Breast cancer G.I. cancer or cervical cancer

Question 8

What work up should be done for this patient in order to help stage and exclude other cancer?

Answer 8

CA-125, abdominal/pelvic CT, CXR, gyn or Gynecological oncology consult, Colonoscopy/FOBT, mammogram, Pap smear, pre-op orders.

Question 9

After ovarian cancer stage two is confirmed we should be done?

Answer 9

Admit the patient to the hospital for surgical resection

Question 10

What is the definitive treatment for ovarian cancer?

Answer 10

Laparotomy for Abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO)

Question 11

What should be done for suspected gastric cancer? Endometrial cancer?

Answer 11

Upper G.I. series, endocervical curettage

Question 12

What could be done if the diagnosis is uncertain?

Answer 12

Obtain biopsy of peritoneal lesions

Question 13

What are the standard a pre-op orders?

Answer 13

ECG, PT, PT/INR, type and crossmatch, NPO, DVT prophylaxis

Question 14

What should be the preop thromboprophylaxis?

Answer 14

Heparin or LMWH plus compression device

Question 15

What should be the preop Parenteral antibiotic prophylaxis?

Answer 15

Cephalosporin (cefazolin) or ampicillin sulbactam

Question 16

Why isn’t laparoscopic resection used in ovarian cancer?

Answer 16

Laparoscopic resection of ovarian cancer is not recommended because complete removal of the tumor is impossible

Question 17

What is the Definitive therapy for ovarian cancer therapy?

Answer 17

Cytoreductive surgery achieved by laparotomy

Question 18

Who should be consulted after the surgery? Why?

Answer 18

Consult oncology for post op adjuvant/Palliative chemotherapy (Carboplatin plus paclitaxel)

Question 19

Why is it important to get C-125 prior to surgery?

Answer 19

To obtain baseline level, rising CA 125. Suggest disease progression

Question 20

What are all the markers for the different cancers?

Answer 20

CEA (colon), CA 19-9 (pancreas), CA-125 (Ovarian)

Question 21

What should be to counseling for this patient?

Answer 21

Cancer diagnosis, no smoking, no alcohol

Question 22

Where is the location for this patient?

Answer 22

Office, home, office, home, office the ward/ER