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Year 4 - O&G > O&G - Gynae-oncology > Flashcards

O&G - Gynae-oncology Flashcards

1
Q

What is interval debulking surgery (IDS)?

A

IDS is several rounds of resection surgery with chemo inbetween e.g.

  1. Primary resection surgery
  2. Several chemo cycles
  3. Secondary resection surgery
  4. Several chemo cycles

This is in contrast to conventional primary debulking surgery + adjuvant chemo

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2
Q

What features on US would raise concern about ovarian malignancy?

A

The following features of Ovarian cysts are suspicious:

  • Large
  • Bilateral
  • Complex i.e. appear to have both solid + cystic areas
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3
Q

What is the general prognosis of Ovarian cancer?

A

Poor

5-year survival of < 35%

(this is because it presents in the advanced stage)

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4
Q

What is an RMI score?

A

RMI = Risk of Malignancy Index

RMI = U x M x CA125

RMI is used to assess risk associated with finding an ovarian cyst & indentify pts who should be referred to speacialist MDT

  • U = ultrasound score (scored out of 5 features)
  • M = menopausal status (1 = pre-menopausal and 3 = post-menopausal)
  • CA125 = marker measured in IU/ml (normal = < 35 IU/ml)
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5
Q

What RMI score is used at the cut-off for specialist referral?

A

RMI > 250 –> refer to specialist

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6
Q

What is required to calculate an RMI score?

A
  1. Menopause status
  2. Blood test for CA125
  3. Transvaginal US of ovaries
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7
Q

What do primary debulking and neoadjuvent chemotherapy?

A

Primary debulking = primary surgery - followed by chemo

Neoadjuvent chemotherapy = chemo with surgery interlaced between cycles

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8
Q

What 4 things need to be covered when informing patients of risks associated with a treatment?

A
  1. Expected benefits
  2. Risk of treatment
  3. Alternative treatments
  4. Consequences of having no treatment
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9
Q

What does Cytoreductive surgery refer to?

A

Cytoreductive surgery = surgery to completely remove all macroscopic (visible) tumours

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10
Q

Name some things that Cytoreductive surgery for ovarian cancer may remove.

A
  • Oophorectomy (uni or bi)
  • Salpingectomy (uni or bi)
  • Hysterectomy
  • Lymphadenectomy (lymph nodes)
  • Omentectomy (removal of omentum - fold of peritoneum)
  • Bowel, spleen and/or liver
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11
Q

What are the most common types of ovarian cancer?

A
  • Epithelial ovarian cancer (90%)
    • 70-80% of these are serous carcinomas
  • Recognised that distal end of fallopian tubes are a common origin site for many ovarian cancers
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12
Q

What are some risk factors for Ovarian Cancer?

A
  1. FHx of BRCA1 or BRCA1 gene mutations
  2. ↑ no. of ovulations - e.g. early menarche, late menopause, nulliparity
    • COCP & pregnancies = protective for ovarian Ca
  3. Subfertility treatments (evidence inconclusive)
  4. Age > 50-yrs
  5. Post-Menopause
  6. ↑ CA125
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13
Q

What are the features of Ovarian Cancer?

A

Notoriously vague

  • Ca Red-flags - weight loss, fever, night sweats
  • Early satiety
  • Post-menopausal PV bleeding
  • Abdominal distention
  • Bloating
  • Abdo / Pelvic pain
  • Urinary symptoms e.g. urgency or frequency
  • Diarrhoea
  • GI symptoms e.g. dyspepsia, nausea
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14
Q

What can cause an ↑ in CA125?

A
  • Ovarian cancer
  • Peritoneal trauma / disease / irritation
  • Cancers of peritoneum, lung, pancreas
  • Endometriosis
  • PID
  • Ovarian - cyst, torsion, rupture or haemorrhage
  • Pregnancy
  • HF
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15
Q

What investigations might you do for ovarian cancer?

A
  1. Full history!!
  2. Abdominal + Pelvic exam
    • Ascites or Abdo / pelvic mass –> 2WW referral
  3. Serum CA125
    • If > 35 IU/ml –> urgent US of abdomen + pelvis
  4. Abdo / pelvic ultrasound –> if suspicious, then 2WW referral
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16
Q

How is Ovarian cancer managed?

A

Combination of surgery + platinum-based chemotherapy

  • Can involve primary debulking or neoadjuvant chemo
  • Can involve interval debulking surgery
17
Q

What are some common side-effects of chemo for ovarian cancer?

A
  1. Hair loss
  2. Nausea & vomiting
  3. Fatigue
18
Q

Which cancers do BRCA1 and BRACA 2 mutations put pts at risk for?

A
  1. Breast
  2. Ovarian
19
Q

What % of high-grade serous ovarian tumours (type of epithelial tumour) are associated with BRCA 1 or BRCA 2 mutations?

A

~ 15% –> thus these pts are offered genetic testing

20
Q

What is Lynparza?

A

It is a PARP-inhibitor (poly-ADP ribose polymerase)

  • PARP - is involved in DNA repair pathways
  • Lynparza inhibits PARP –> which in cancer cells causes gross loss of DNA repair and ultimately cell-death
  • Lynparza also inhibits PARP in healthy cells, however these have an alternative DNA repair pathway not seen in cancer cells –> thus can still repair DNA
21
Q

When calculating an RMI score for ovarian cancer - what features score on ultrasound (5 in total)?

RMI = U x M x CA125

A

Ultrasound features of ovarian cancer that score on RMI:

  1. Multilocular cysts
  2. Solid areas
  3. Metastases
  4. Ascites
  5. Bilateral lesions

Year 4 - O&G (12 decks)

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