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Ovarian cancer > Epithelial Ovarian Cancer > Flashcards

Epithelial Ovarian Cancer Flashcards

1
Q

How common is ovarian cancer

A

1:70 women

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2
Q

Risk factors for ovarian cancer

A

age
increased number of ovulations:

nulliparity, early menarche, late menopause

family history
BRCA 1 or BRCA 2

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3
Q

Protective factors for ovarian cancer

A

fewer ovulations:
COCP
breast feeding

tubal ligation

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4
Q

What proportion of invasive epithelial ovarian cancer is autosomal dominant genetic (BRCA1/2)?

A

15-20%

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5
Q

What is the lifetime ovarian cancer risk for BRCA1?

A

40%

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6
Q

What is the lifetime ovarian cancer risk for BRCA2?

A

20%

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7
Q

What are the other genetic mutations linked to ovarian cancer?

A

Lynch syndrome - MLH1 MSH2 MSH6 PMS2

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8
Q

What is the lifetime ovarian cancer risk for Lynch syndrome

and which ovarian cancer is associated?

A

10-13%

endometrioid

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9
Q

What types of epithelial tumours of the ovary are there?

A 
High grade serous
Low grade serous
Mucinous
Clear cell
Endometrioid
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10
Q

Where do most high grade serous lesions originate from

A

STIC lesions (serous tubal intraepithelial carcinoma) in the distal fallopian tube

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11
Q

Where do clear cell and endometrioid ovarian carcinomas originate from?

A

endometriomas - and go through a hyperplasia, borderline tumour, carcinoma sequence

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12
Q

where do mucinous carcinomas come from?

A

mucinous cystadenomas - to borderline mucinous - to intraepithelial carcinoma

Usually arise from transitional cell metaplasia or mets from GI origin

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13
Q

What might fertility medications increase?

A

Borderline ovarian tumours

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14
Q

What proportion of serous tumours are malignant?

A

20%

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15
Q

What proportion of serous tumours are borderline?

A

2%

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16
Q

What proportion of serous tumours are benign?

A

78%

17
Q

What proportion of serous adenomas are bilateral?

A

1:6

18
Q

What proportion of stage 1 serous adenocarcinomas are bilateral?

A

1:3

and 2:3 in higher staging

19
Q

Which immunohistochemistry is linked to a serous carcinoma?

A

WT1
cytokeratin (CK)7
negative or focally positive for CK20 and calretinin

20
Q

Which other cancers have a similar CK7/20 profile as serous carcinomas?

A

pancreatic and breast

21
Q

What percentage of ovarian mucinous carcinomas are primary or secondary?

A

30% primary

70% secondary

22
Q

What makes you think a mucinous carcinoma is more likely to be a secondary?

A 
bilateral
smaller in size (less than 10cm)
ovarian surface involvement
nodular pattern of involvement
infiltrative pattern of stromal involvement
23
Q

What types of primary ovarian mucinous tumours are there?

A 
cystadenomas (81%)
borderline tumours (13%)
primary ovarian mucinous carcinomas (5%)
24
Q

What are the two types of borderline mucinous tumours?

A 
Endocervical 
gastrointestinal (most common)
25
Q

What is an alternative presentation of mucinous neoplasia?

what is it and where does it arise from?

A

Pseudomyxoma peritonei

mucinous ascites with accompanied low grade neoplastic mucinous epithelium

arises from appendiceal low grade adenomatous mucinous tumours.

26
Q

What percentage of ovarian mucinous carcinomas are primary or secondary?

A

30% primary

70% secondary

27
Q

What makes you think a mucinous carcinoma is more likely to be a secondary?

A 
bilateral
smaller in size (less than 10cm)
ovarian surface involvement
nodular pattern of involvement
infiltrative pattern of stromal involvement
28
Q

What types of primary ovarian mucinous tumours are there?

A 
cystadenomas (81%)
borderline tumours (13%)
primary ovarian mucinous carcinomas (5%)
29
Q

What are the hallmark features of a clear cell ovarian carcinomas?

A

Clear and ‘hobnail’ cells microscopically

Clear cytoplasm as the glycogen has leached as the tissue is prepared

Hobnail cells - bulbous nuclei protruding in to the lumen

30
Q

What is an alternative presentation of mucinous neoplasia?

what is it and where does it arise from?

A

Pseudomyxoma peritonei

mucinous ascites with accompanied low grade neoplastic mucinous epithelium

arises from appendiceal low grade adenomatous mucinous tumours.

31
Q

What proportion of ovarian carcinomas are endometrioid?

A

10%

32
Q

What proportion of endometrioid ovarian cancers are associated with endometriosis?

A

10-40%

33
Q

In women of reproductive age who have an endometrioid endometrial cancer - how often is this associated with a synchronous primary endometrioid ovarian cancer?

A

25%

34
Q

What are the hallmark features of a clear cell ovarian carcinomas?

A

Clear and ‘hobnail’ cells microscopically

Clear cytoplasm as the glycogen has leached as the tissue is prepared

Hobnail cells - bulbous nuclei protruding in to the lumen

35
Q

Name some other more rare types of ovarian carcinoma

A

carcinosarcoma - mixed epithelial and stromal

Mixed carcinoma (two histological cell types) - eg clear cell and endometrioid

Fallopian tube cancer

Primary peritoneal serous carcinoma

36
Q

What is the most common histological type for fallopian tube cancer?

A

Papillary serous

37
Q

How do you define primary peritoneal?

A

GOG

  1. ovaries normal size or enlarged benign cause
  2. no ovarian involvement or just on surface. no ovarian tumour nodule in ovarian cortex over 5x5mm
  3. serous histology
  4. more extraovarian than ovarian disease in volume.

Ovarian cancer (4 decks)

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