Lecture 24: Pathophysiology of Ovarian Cancer

Question 1

What are the 4 types of ovarian cancer?

Answer 1

1. Epithelial
2. Germ Cell
3. Sex cord
4. Metastatic

Question 2

What are the different types of epithelial ovarian cancers?

Answer 2

1. Benign (cystadenoma)
2. Borderline (low malignant potential)
3. Frankly Invasive (Cystadenocarcinomas)

Question 3

What are the different subtypes of epithelial ovarian cancer?

Answer 3

1. Serous (42%)
   
   • similar to fallopian tube epithelium
   • CA-125 is a good tumor marker
2. Mucinous (12%)
   
   • like endocervical epithelium
   • CA-19-9
3. Endometrioid
4. Clear cell
5. Brenner (transitional epithelium)
6. Undifferentiated (17%)

Question 4

What does low malignant potential (LMP) tumors mean?

Answer 4

Borderline tumors
NOT malignant
Presents at lower age and does NOT invade

Question 5

When do most patients present with epithelial ovarian cancer?

Answer 5

Older ages
Late stages
Diseasae has already escaped the ovary
That’s why ovarian cancer tends to be so deadly

Question 6

What are the routes of spread of ovarian cancer?

Answer 6

1. Peritoneal
2. Direct extension
3. Lymphatic spread
4. Hematogenous spread

Question 7

What is CA-125?

Answer 7

Stands for cancer antigen 125 or carbohydrate antigen 125
Aka Mucin 16 or MUC16
Encodes for mucin
Tumor marker that may be elevated in patients with ovarian cancer

Question 8

If you have a high CA125?

Answer 8

Non-specific

But could be indicative of ovarian cancer

Question 9

If patient has ascites, omental caking and pelvic mass, what is the leading item on differential?

Answer 9

Ovarian cancer

Question 10

Is there screening for ovarian cancer?

Answer 10

No

Question 11

What is the overall 5 year survival of ovarian cancer? Significance?

Answer 11

25%

23% of gyn cancers are ovarian in origin but 50% of gyn cancer deaths are due to ovarian cancer!!

Question 12

What are the theories of pathogenesis of epithelial ovarian cancer?

Answer 12

1. Theory of incessant ovulation
   
   • uninterrupted periods of ovulation lead to ovarian surface trauma, metaplasia, and eventually carcinogenesis
2. Excess gonadotropins
   
   • excess estrogen exposure causes hyperplasia of the ovarian surface epithelium that over time leads to carcinogenesis

Question 13

How do you treat ovarian cancer?

Answer 13

1. Staging
   -requires large vertical incision
   -washings, biopsies
   -examination of all serosal surfaces
   -lymph node sampling
   -tumor debulking
2. Surgical Cytoreduction
   Adjuvant chemotherapy

Question 14

What are drug used in chemotherapy for ovarian cancer?

Answer 14

Carboplatin + Paclitaxel = 3-6 cycles

Question 15

How do patients usually present with ovarian cancer?

Answer 15

Asymptomatic mass
Abdominal swelling/pain
Urinary frequency
Weight change
Dyspepsia (indigestion)
Ascites

Question 16

What are germ cell cancers?

Answer 16

Teratomas

Question 17

How do patients with germ cell tumors present?

Answer 17

Present at younger ages (in relation to epithelial tumors)
Limited to SINGLE affected ovary
Usually spreads lymphatically vs. peritoneally (epithelial)

Question 18

What is the pathogenesis of germ cell tumors?

Answer 18

Abnormal differentiation of fetal germ cells

Question 19

What are the risk factors for ovarian cancer?

Answer 19

1. Infertile patient
2. Don’t breastfeed
3. No children (nulliparity)
4. BRCA1 and BRCA2
5. Jewish descent
6. HNPCC mutatiosn
7. Over 50 yo
8. coffee, fat, low fiber and low Vit A

Question 20

Why is the peritoneum considered the secondary mullerian system?

Answer 20

Because they are composed of same cells that cover the ovary

-treatment of primary peritoneal cancer is treated the same way as ovarian