Gyne malignancy - ovarian cancer Flashcards
what are the 3 major categories of ovarian cancer
- germ cell tumors = PGCs - favorable
- stromal tumors - sex cords - bad
- carcinoma - coelomic epithelium - worst
Primordial germ cell tumor characteristics
- very chemosensitive, curable
Examples of PGC tumors
- teratoma
- dysgerminoma
- embryonal
- chriocarcinoma
- gonadoblastoma
Majority of germ cell tumors are (95%)
Mature teratomas
Only benign germ cell tumor is
mature teratoma
Types of sex cord tumors/stromal tumor
- granulosa cell
- thecoma
- sertoli-leydig tumor
Characteristics of stromal tumors (3-5%)
- least common
post-menopausal - affects women all ages
Examples of epithelial tumors (80-85%)
- serous (fallopian tube)
- endometrioid
- mucinous
- clear cell
- Brenner
Most common epithelial tumor
serous - aggressive
Gross appearance of a serous cancer
- bilateral ovarian involvement
- solid, cystic, papillary projection
Psammoma bodies are characteristic of which tumor?
serous ca
unilateral mass, mucinous producing, multicystic often
mucinous cancer
Unilateral mass, hemorrhagic
endometrioid
Unilateral mass, solid, and cystic, sometimes hemorrhagic
clear cell - same as clear cell endometrial
Risk factors for ovarian cancer
- nulliparity
- early menarche
- OCPs protective
- genetics
2 familial syndromes associated with Ov Ca
- BRCA mutations
- Lynch syndrome
- only 10% hereditary
Which 2 tests are not useful in detecting ovarian cancer?
Ultrasound and CA-125
Warning symptoms of ovarian cancer
- asymptomatic
- bloating
- abdo pain
- irregular vaginal bleeding
- fatigue weight loss
What is a tumor marker for epithelial non-mucinous ov ca?
- CA-125 - DIAGNOSTIC NOT A SCREEN
Marker for a Dysgerminoma
- LDH
Marker for an endodermal sinus
AFP - liver
Marker for an Immature teratoma
NONE
Marker for stromal, granulosa cell
Inhibin
CA125 has low
specificity
CA125 is not good at identifying
early stage disease
what is the RMI calculation for adnexal masses?
U x M x CA125
“U” in the RMI calculation is
1 point for (multilocularity, bilateralitym solid components, ascites, evidence of mets)
U = 0 or 1
U = 4 otherwise
“M” in the RMI calculation is
4 points if post menopausal
1 point if premenopausal
at which RMI value do you refer to a gyne onc
RMI> 200
Roles of surgical management of ovarian cancer
- stage
- diagnose
- debulk -
- adjuvant therapy optimize - intraperitoneal chemo
which nodes are draining ovaries
para-aortic
pelvic nodes
which diaphragm is at risk in ovarian cancer
Right diaphragm
GOALs of debulking
- remove gross tumor at initial operation
Prognostic factors in ov cancer
- stage at presentation
- optimal debulking of advanced disease
- biology of tumor
When are the majority of patients with epithelial ov cancer diagnosed?
advanced stage 3 or 4
