Gyne malignancy - ovarian cancer

Question 1

what are the 3 major categories of ovarian cancer

Answer 1

• germ cell tumors = PGCs - favorable
• stromal tumors - sex cords - bad
• carcinoma - coelomic epithelium - worst

Question 2

Primordial germ cell tumor characteristics

Answer 2

• very chemosensitive, curable

Question 3

Examples of PGC tumors

Answer 3

• teratoma
• dysgerminoma
• embryonal
• chriocarcinoma
• gonadoblastoma

Question 4

Majority of germ cell tumors are (95%)

Answer 4

Mature teratomas

Question 5

Only benign germ cell tumor is

Answer 5

mature teratoma

Question 6

Types of sex cord tumors/stromal tumor

Answer 6

• granulosa cell
• thecoma
• sertoli-leydig tumor

Question 7

Characteristics of stromal tumors (3-5%)

Answer 7

• least common

post-menopausal - affects women all ages

Question 8

Examples of epithelial tumors (80-85%)

Answer 8

• serous (fallopian tube)
• endometrioid
• mucinous
• clear cell
• Brenner

Question 9

Most common epithelial tumor

Answer 9

serous - aggressive

Question 10

Gross appearance of a serous cancer

Answer 10

• bilateral ovarian involvement

- solid, cystic, papillary projection

Question 11

Psammoma bodies are characteristic of which tumor?

Answer 11

serous ca

Question 12

unilateral mass, mucinous producing, multicystic often

Answer 12

mucinous cancer

Question 13

Unilateral mass, hemorrhagic

Answer 13

endometrioid

Question 14

Unilateral mass, solid, and cystic, sometimes hemorrhagic

Answer 14

clear cell - same as clear cell endometrial

Question 15

Risk factors for ovarian cancer

Answer 15

• nulliparity
• early menarche
• OCPs protective
• genetics

Question 16

2 familial syndromes associated with Ov Ca

Answer 16

• BRCA mutations
• Lynch syndrome
• only 10% hereditary

Question 17

Which 2 tests are not useful in detecting ovarian cancer?

Answer 17

Ultrasound and CA-125

Question 18

Warning symptoms of ovarian cancer

Answer 18

• asymptomatic
• bloating
• abdo pain
• irregular vaginal bleeding
• fatigue weight loss

Question 19

What is a tumor marker for epithelial non-mucinous ov ca?

Answer 19

• CA-125 - DIAGNOSTIC NOT A SCREEN

Question 20

Marker for a Dysgerminoma

Answer 20

• LDH

Question 21

Marker for an endodermal sinus

Answer 21

AFP - liver

Question 22

Marker for an Immature teratoma

Answer 22

NONE

Question 23

Marker for stromal, granulosa cell

Answer 23

Inhibin

Question 24

CA125 has low

Answer 24

specificity

Question 25

CA125 is not good at identifying

Answer 25

early stage disease

Question 26

what is the RMI calculation for adnexal masses?

Answer 26

U x M x CA125

Question 27

“U” in the RMI calculation is

Answer 27

1 point for (multilocularity, bilateralitym solid components, ascites, evidence of mets)
U = 0 or 1
U = 4 otherwise

Question 28

“M” in the RMI calculation is

Answer 28

4 points if post menopausal

1 point if premenopausal

Question 29

at which RMI value do you refer to a gyne onc

Answer 29

RMI> 200

Question 30

Roles of surgical management of ovarian cancer

Answer 30

• stage
• diagnose
• debulk -
• adjuvant therapy optimize - intraperitoneal chemo

Question 31

which nodes are draining ovaries

Answer 31

para-aortic

pelvic nodes

Question 32

which diaphragm is at risk in ovarian cancer

Answer 32

Right diaphragm

Question 33

GOALs of debulking

Answer 33

• remove gross tumor at initial operation

Question 34

Prognostic factors in ov cancer

Answer 34

• stage at presentation
• optimal debulking of advanced disease
• biology of tumor

Question 35

When are the majority of patients with epithelial ov cancer diagnosed?

Answer 35

advanced stage 3 or 4