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Ph RadOnc Residency PBRROE2-3 Review 2021 > Ovarian and Fallopian Tube Cancer > Flashcards

Ovarian and Fallopian Tube Cancer Flashcards

1
Q

Ovarian and Fallopian Tube Cancer

BONUS

Metastasis to the ovary from gastrointestinal malignancy.

A

Krukenberg tumors

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2
Q

Ovarian and Fallopian Tube Cancer

What is the histology of the outer cortex of the ovary?

A

pseudocolumnar or cuboidal epithelium, termed the germinal epithelium of Waldeyer or ovarian surface epithelium (OSE)

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3
Q

Ovarian and Fallopian Tube Cancer

The primary lymphatic drainage of the
ovary parallels the course of the ovarian arteries, with secondary lymphatic flow
passing through the inguinal canal and to the iliac nodal system.

TRUE or FALSE?

A

False.

it’s veins not arteries

read. 1 point is 1 point sa exam. Sayang.
Examiners are not always fair. hahaha

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4
Q

Ovarian and Fallopian Tube Cancer

What is the arterial supply of the ovaries?

the fallopian tubes?

A

ovaries: ovarian artery

fallopian tubes: ovarian and uterine ateries.

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5
Q

Ovarian and Fallopian Tube Cancer

The venous drainage of the fallopian tubes is through the Batson’s plexus to the ovarian vein and uterine plexus.

TRUE or FALSE?

A

False.

pampiniform not batson

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6
Q

Ovarian and Fallopian Tube Cancer

The fallopian tubes consist of four separate histologic layers: the mucosa, submucosa, muscularis (external longitudinal and inner circular layers), and outer serosal layer, which is continuous with the visceral peritoneum of the uterus.

TRUE or FALSE?

A

True.

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7
Q

Ovarian and Fallopian Tube Cancer

What is the most common histology of primary “fallopian tube” tumors?

A

high-grade serous carcinoma

papillary serous adenocarcinoma

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8
Q

Ovarian and Fallopian Tube Cancer

What is the precursor lesion of primary fallopian tube tumors?

A

serous tubal intraepithelial carcinomas (STICs)

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9
Q

Ovarian and Fallopian Tube Cancer

Two-pathway model.
Identify whether type 1 or 2.

High-grade serous carcinoma

A

Type 2

All müllerian subtypes (serous, endometrioid,
mucinous, clear cell, transitional) are type 1

In general, type 1 are low grades, type 2 are high grades

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10
Q

Ovarian and Fallopian Tube Cancer

Two-pathway model.
Identify whether type 1 or 2.

activated MAPK pathway (KRAS or BRAF mutation)

A

Type 1

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11
Q

Ovarian and Fallopian Tube Cancer

Two-pathway model.
Identify whether type 1 or 2.

activated PI3K pathway (PIK3CA or PTEN mutation)

A

Type 1

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12
Q

Ovarian and Fallopian Tube Cancer

Two-pathway model.
Identify whether type 1 or 2.

loss of BAF250a expression (ARID1a mutation)

A

Type 1

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13
Q

Ovarian and Fallopian Tube Cancer

Two-pathway model.
Identify whether type 1 or 2.

Inactivation of BRCA pathway

A

Type 2

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14
Q

Ovarian and Fallopian Tube Cancer

Two-pathway model.
Identify whether type 1 or 2.

High frequency p53 mutation

A

Type 2

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15
Q

Ovarian and Fallopian Tube Cancer

Two-pathway model.
Identify whether type 1 or 2.

Widespread DNA copy number change

A

Type 2

Type 1 is usually chromosomally stable

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16
Q

Ovarian and Fallopian Tube Cancer

Two-pathway model.
Identify whether type 1 or 2.

Usually platinum sensitive

A

Type 2

Type 1 is usually insensitive

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17
Q

Ovarian and Fallopian Tube Cancer

Main patient-related risk factor?

A

increased frequency of ovulation/incessant ovulation

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18
Q

Ovarian and Fallopian Tube Cancer

OCP use reduces the risk of ovarian cancer.

TRUE or FALSE?

A

True

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19
Q

Ovarian and Fallopian Tube Cancer

Estrogen (HRT) reduces the risk of ovarian cancer.

TRUE or FALSE?

A

False.

Exogenous estrogen increases the risk, as well as elevated androgens.

Progestins are protective.

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20
Q

Ovarian and Fallopian Tube Cancer

Ovarian cancers can arise from PCOS and endometriosis.
Those that arise from endometriosis are most often low-grade tumors with endometrioid or clear cell histology and are associated with a better prognosis.

TRUE or FALSE?

A

True.

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21
Q

Ovarian and Fallopian Tube Cancer

I. BRCA-associated ovarian cancers are most frequently invasive serous adenocarcinomas and less likely borderline or mucinous tumors.

II. Mutation carriers are also more likely to present with advanced-stage disease and have poorly differentiated tumors.

III. BRCA1 or BRCA2 mutation carriers have a more unfavorable clinical course with a significantly shorter recurrence-free and overall survival compared to noncarriers.

Which statement is FALSE?

A

III.

favorable clinical course with a significantly longer recurrence-free and overall survival compared to noncarriers

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22
Q

Ovarian and Fallopian Tube Cancer

Aside from BRCA mutations, what is the other syndrome accounting for the remaining 10% of hereditary ovarian cancers?

Ovarian cancer associated with this syndrome is more often diagnosed at an earlier stage with well- to moderately differentiated tumor grade in contrast to BRCA associated cancers.

A

HNPCC or Lynch II syndrome

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23
Q

Ovarian and Fallopian Tube Cancer

What are the three procedures (lab/imaging/surgical procedure) that are used for screening (although the efficacy of screening has been disappointing in the high-risk population)?

A

CA-125
TVUS
laparotomy (surgical)

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24
Q

Ovarian and Fallopian Tube Cancer

Most common type of ovarian tumor/malignancies?

A

epithelial
***
Most
ovarian malignancies (60% to 65%) are epithelial, with germ cell tumors (20%),
sex cord–stromal tumors (5%), and metastases to the ovary (5% to 10%)
accounting for the remainder.

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25
Q

Ovarian and Fallopian Tube Cancer

Most common type of ovarian “epithelial” tumor?

A

serous
***
Serous tumors are most common, comprising
50% to 60% of epithelial tumors. Other subtypes include mucinous carcinoma in
10%; endometrioid carcinoma, 8%; clear cell carcinoma, 3% to 5%; transitional,
3% to 5%; and undifferentiated carcinoma, 1%.

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26
Q

Ovarian and Fallopian Tube Cancer

Bilateral ovarian involvement, small multinodular ovaries, and surface and hilar spread
likely represents a primary ovarian tumor.

A large, cystic, unilateral tumor of low grade arising in a focus of endometriosis suggests metastatic involvement from an endometrial primary.

TRUE or FALSE?

A

False.
***
Bilateral ovarian involvement, small multinodular ovaries, and surface and hilar spread suggest metastatic involvement from an endometrial primary, particularly if the endometrial tumor is high grade, deeply invasive, and associated with lymphovascular invasion.
A large, cystic, unilateral tumor of low grade arising in a focus of endometriosis likely represents a primary ovarian tumor.

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27
Q

Ovarian and Fallopian Tube Cancer

Word association:

Schiller-Duval bodies

A

Endodermal

sinus tumors, also known as yolk sac tumors

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28
Q

Ovarian and Fallopian Tube Cancer

Word association:

Call-Exner body

A

granulosa cell tumors

the most common sex cord–stromal tumor

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29
Q

Ovarian and Fallopian Tube Cancer

What is the primary mode of spread of ovarian cancers?

A

Transperitoneal

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30
Q

Ovarian and Fallopian Tube Cancer

What is the most common extrapelvic finding in stage IV disease?

A

Transdiaphragmatic spread occurs to the pleural cavity and is the most
common finding in stage IV disease

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31
Q

Ovarian and Fallopian Tube Cancer

FIGO Staging

Pleural effusion with positive cytology

A

IVA

IVB (is parenchymal metastasis including liver and spleen, and other extra-abdominal and distant organs)

32
Q

Ovarian and Fallopian Tube Cancer

FIGO Staging

Inguinal nodal involvement

A

IVB

considered distant
remember, the primary spread is transperitoneal

33
Q

Ovarian and Fallopian Tube Cancer

FIGO Staging

Spleen or liver capsule involvement

A

IIIC

34
Q

Ovarian and Fallopian Tube Cancer

FIGO Staging

Macroscopic peritoneal metastases (above pelvic brim) >2 cm

A

IIIB

IIIA is microscopic IIIB

35
Q

Ovarian and Fallopian Tube Cancer

FIGO Staging

Minimum stage if there is a positive retroperitoneal lymph node?

A

IIIA1

IIIA1i (≤10 mm)
IIIA1ii if (10 mm)

can be IIIB, C, depending on other parameters not related to retroperitoneal lymph nodes.

36
Q

Ovarian and Fallopian Tube Cancer

FIGO Staging

Uterine involvement

A

IIA (including FT and ovaries)

IIB if other intraperitoneal pelvic tissues, below the pelvic brim

37
Q

Ovarian and Fallopian Tube Cancer

FIGO Staging

Surgical spill of ovarian or fallopian tube contents

A

IC1

38
Q

Ovarian and Fallopian Tube Cancer

FIGO Staging

Ovarian capsule rupture prior to surgery

A

IC2

39
Q

Ovarian and Fallopian Tube Cancer

FIGO Staging

Positive peritoneal washings

A

IC3

40
Q

Ovarian and Fallopian Tube Cancer

What are the criteria for pre-menopausal women who can undergo fertility sparing surgery?

A

stage I
(stage 1A or 1C, but not 1B)
because IB is bilateral

and/or

low-risk tumors (early-stage, low-grade invasive tumors, LMP/borderline
lesions, or malignant stromal or germ cell tumors).

41
Q

Ovarian and Fallopian Tube Cancer

What are the most important determinants of survival?

A

stage
grade
histology
optimal cytoreduction

42
Q

Ovarian and Fallopian Tube Cancer

Regarding cytoreduction, what is the GOG definition of:
optimal
complete
suboptimal?

A

complete: no gross visible disease

optimal - residual tumor ≤ 1 cm

suboptimal - residual tumor nodules greater than 1 cm

43
Q

Ovarian and Fallopian Tube Cancer

Optimal cytoreduction confers improvement in median survival compared to suboptimal cytoreduction.

TRUE or FALSE?

A

True

44
Q

Ovarian and Fallopian Tube Cancer

Preoperative CA-125 measurement is independently prognostic, as it likely reflects disease burden

TRUE or FALSE?

A

False.

Preoperative CA-125 measurement is not
independently prognostic, as it likely reflects disease burden. In contrast, the
half-life and nadir of CA-125 during induction chemotherapy are associated with
improved outcome in ovarian and fallopian tube cancers

45
Q

Ovarian and Fallopian Tube Cancer

Management of Epithelial Ovarian Cancer

Stage IA/B grade 1

A

Observation

46
Q

Ovarian and Fallopian Tube Cancer

Management of Epithelial Ovarian Cancer

Stage IA/B grade 2

A

Observation
or
IV taxane/carboplatin for 3–6 cycles

47
Q

Ovarian and Fallopian Tube Cancer

Management of Epithelial Ovarian Cancer

Stage IA/B grade 3

A

IV taxane/carboplatin for 3–6 cycles

48
Q

Ovarian and Fallopian Tube Cancer

Management of Epithelial Ovarian Cancer

Stage IA/B grade 3

A

IV taxane/carboplatin for 3–6 cycles

49
Q

Ovarian and Fallopian Tube Cancer

Management of Epithelial Ovarian Cancer

Stage II grade II

A

IV taxane/carboplatin for 6 cycles

or

IP chemotherapy in optimally cytoreduced patients

50
Q

Ovarian and Fallopian Tube Cancer

Management of Epithelial Ovarian Cancer

Stage III optimally cytoreduced

A 
IP chemotherapy
or
IV taxane/carboplatin for 6 cycles
or
clinical trial
51
Q

Ovarian and Fallopian Tube Cancer

Management of Epithelial Ovarian Cancer

Stage III suboptimally cytoreduced

Stage IV

A 
IV taxane/carboplatin for 6 cycles
or
clinical trial
or
interval cytoreduction if indicated by tumor response and resectability
52
Q

Ovarian and Fallopian Tube Cancer

What are the two trials that showed a benefit to platinum-based chemotherapy for early stage cancer?

What are the stages included in their treatment arms?

A

ICON1 (I/II)

and

ACTION (IA, IB, grades 2-3, IC-IIA all grades, clear cell)

53
Q

Ovarian and Fallopian Tube Cancer

What group conducted trial that compared 3 vs 6 cycles of chemotherapy (carboplatin and taxol) in early stage cancer which showed no survival difference?

What group had the greatest benefit?

A

GOG

serous tumors

54
Q

Ovarian and Fallopian Tube Cancer

In the study from PMH, the greatest benefit to the addition of WAI is seen on what subgroup of patients?

A

<2 cm residual.

55
Q

Ovarian and Fallopian Tube Cancer

WAI was proven comparable to chemotherapy in the adjuvant setting (MDA/Italian study) and was shown to have OS benefit by the PMH experience.

Why is adjuvant WAI not routinely adapted in practice?

A

toxicity.

also no level I evidence

56
Q

Ovarian and Fallopian Tube Cancer

Usual Dose: WAI

A

45 Gy to the pelvis, 22.5 to the whole abdomen (up to 30 with boost to paraaortic nodes up t 45-50 Gy)

57
Q

Ovarian and Fallopian Tube Cancer

What histologies of early-stage ovarian cancer usually benefit from consolidative RT?

A

clear-cell, mucinous, and endometrioid

not in serous

58
Q

Ovarian and Fallopian Tube Cancer

What type of chemotherapy drug was found out to be the most active class in ovarian cancer treatment as was proven by the meta-analysis of 49 trials from the Advanced Ovarian Cancer Trialists’ Group?

A

platinum-based

59
Q

Ovarian and Fallopian Tube Cancer

What radiocolloid is used in intraperitoneally in the treatment of ovarian cancers?

A

32P

60
Q

Ovarian and Fallopian Tube Cancer

What was approved as maintenance therapy was recently granted FDA approval based on the results of the SOLO-2 trial, which showed a significant improvement in progression-free survival in patients with germline BRCA-mutated, platinum-sensitive recurrent ovarian cancer when compared to placebo.

A

Olaparib

61
Q

Ovarian and Fallopian Tube Cancer

This agent was approved by FDA for patients with recurrent germline BRCA-mutated ovarian cancer who have received three
or more prior lines of chemotherapy or as maintenance therapy following
response to platinum therapy for those with platinum-sensitive recurrence.

A

Olaparib

62
Q

Ovarian and Fallopian Tube Cancer

This agent was approved by FDA for patients with with BRCA-mutated ovarian cancer (either deleterious
tumor or germline mutation) who have received at least two prior lines of
chemotherapy.

A

Rucaparib

63
Q

Ovarian and Fallopian Tube Cancer

This agent was approved by FDA for platinum-sensitive recurrent ovarian cancer
patients as maintenance therapy following response to platinum-based
chemotherapy, regardless of BRCA or tumor homologous recombination status.

A

Niraparib

64
Q

Ovarian and Fallopian Tube Cancer

Response to palliative RT is dependent on the recurrent tumor’s sensitivity to platinum second-line chemotherapy.

TRUE or FALSE?

A

Duh!

Of course not.

65
Q

Ovarian and Fallopian Tube Cancer

What is the most common ovarian germ cell tumor?

A

mature cystic teratoma

66
Q

Ovarian and Fallopian Tube Cancer

What is the most common ovarian neoplasm?

A

mature cystic teratoma

67
Q

Ovarian and Fallopian Tube Cancer

What is the most common malignant ovarian germ cell tumor?

A

dysgerminoma

68
Q

Ovarian and Fallopian Tube Cancer

Dysgerminoma

Postoperative management for stage I dysgerminoma

A

observation.

69
Q

Ovarian and Fallopian Tube Cancer

Dysgerminoma

Postoperative management for advanced-stage disease?

A

four cycles of BEP chemotherapy (bleomycin, etoposide, cisplatin)

70
Q

Ovarian and Fallopian Tube Cancer

Dysgerminoma

adjuvant RT dose?

A

25 Gy in 12 to 14 fx (1.8)

71
Q

Ovarian and Fallopian Tube Cancer

Dysgerminoma has the highest bilaterality rate among germ cell tumors of the ovary.

TRUE or FALSE?

A

True

72
Q

Ovarian and Fallopian Tube Cancer

What is the NCCN recommended treatment for well-staged patients with resected ovarian nondysgerminoma GCTs?

A

3-4 cycles of BEP

73
Q

Ovarian and Fallopian Tube Cancer

What is the NCCN recommended treatment for resected ovarian nondysgerminoma GCTs with gross residual or stage IV disease?

A

6 cycles of chemotherapy

74
Q

Ovarian and Fallopian Tube Cancer

Most common presenation of juvenile granulosa cell tumor

A

abdominal mass

75
Q

Ovarian and Fallopian Tube Cancer

Surgical treatment in premenopausal women with early stage granulosa cell tumors?

A

unilateral SO (USO)

Ph RadOnc Residency PBRROE2-3 Review 2021 (57 decks)

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