Epithelial Ovarian Cancer Flashcards
How common is ovarian cancer
1:70 women
Risk factors for ovarian cancer
age
increased number of ovulations:
nulliparity, early menarche, late menopause
family history
BRCA 1 or BRCA 2
Protective factors for ovarian cancer
fewer ovulations:
COCP
breast feeding
tubal ligation
What proportion of invasive epithelial ovarian cancer is autosomal dominant genetic (BRCA1/2)?
15-20%
What is the lifetime ovarian cancer risk for BRCA1?
40%
What is the lifetime ovarian cancer risk for BRCA2?
20%
What are the other genetic mutations linked to ovarian cancer?
Lynch syndrome - MLH1 MSH2 MSH6 PMS2
What is the lifetime ovarian cancer risk for Lynch syndrome
and which ovarian cancer is associated?
10-13%
endometrioid
What types of epithelial tumours of the ovary are there?
High grade serous Low grade serous Mucinous Clear cell Endometrioid
Where do most high grade serous lesions originate from
STIC lesions (serous tubal intraepithelial carcinoma) in the distal fallopian tube
Where do clear cell and endometrioid ovarian carcinomas originate from?
endometriomas - and go through a hyperplasia, borderline tumour, carcinoma sequence
where do mucinous carcinomas come from?
mucinous cystadenomas - to borderline mucinous - to intraepithelial carcinoma
Usually arise from transitional cell metaplasia or mets from GI origin
What might fertility medications increase?
Borderline ovarian tumours
What proportion of serous tumours are malignant?
20%
What proportion of serous tumours are borderline?
2%
What proportion of serous tumours are benign?
78%
What proportion of serous adenomas are bilateral?
1:6
What proportion of stage 1 serous adenocarcinomas are bilateral?
1:3
and 2:3 in higher staging
Which immunohistochemistry is linked to a serous carcinoma?
WT1
cytokeratin (CK)7
negative or focally positive for CK20 and calretinin
Which other cancers have a similar CK7/20 profile as serous carcinomas?
pancreatic and breast
What percentage of ovarian mucinous carcinomas are primary or secondary?
30% primary
70% secondary
What makes you think a mucinous carcinoma is more likely to be a secondary?
bilateral smaller in size (less than 10cm) ovarian surface involvement nodular pattern of involvement infiltrative pattern of stromal involvement
What types of primary ovarian mucinous tumours are there?
cystadenomas (81%) borderline tumours (13%) primary ovarian mucinous carcinomas (5%)
What are the two types of borderline mucinous tumours?
Endocervical gastrointestinal (most common)
What is an alternative presentation of mucinous neoplasia?
what is it and where does it arise from?
Pseudomyxoma peritonei
mucinous ascites with accompanied low grade neoplastic mucinous epithelium
arises from appendiceal low grade adenomatous mucinous tumours.
What percentage of ovarian mucinous carcinomas are primary or secondary?
30% primary
70% secondary
What makes you think a mucinous carcinoma is more likely to be a secondary?
bilateral smaller in size (less than 10cm) ovarian surface involvement nodular pattern of involvement infiltrative pattern of stromal involvement
What types of primary ovarian mucinous tumours are there?
cystadenomas (81%) borderline tumours (13%) primary ovarian mucinous carcinomas (5%)
What are the hallmark features of a clear cell ovarian carcinomas?
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
What is an alternative presentation of mucinous neoplasia?
what is it and where does it arise from?
Pseudomyxoma peritonei
mucinous ascites with accompanied low grade neoplastic mucinous epithelium
arises from appendiceal low grade adenomatous mucinous tumours.
What proportion of ovarian carcinomas are endometrioid?
10%
What proportion of endometrioid ovarian cancers are associated with endometriosis?
10-40%
In women of reproductive age who have an endometrioid endometrial cancer - how often is this associated with a synchronous primary endometrioid ovarian cancer?
25%
What are the hallmark features of a clear cell ovarian carcinomas?
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
Name some other more rare types of ovarian carcinoma
carcinosarcoma - mixed epithelial and stromal
Mixed carcinoma (two histological cell types) - eg clear cell and endometrioid
Fallopian tube cancer
Primary peritoneal serous carcinoma
What is the most common histological type for fallopian tube cancer?
Papillary serous
How do you define primary peritoneal?
GOG
- ovaries normal size or enlarged benign cause
- no ovarian involvement or just on surface. no ovarian tumour nodule in ovarian cortex over 5x5mm
- serous histology
- more extraovarian than ovarian disease in volume.
