Ovarian and Fallopian Tube Tumors Flashcards
What is the 5 year survival for ovarian cancer and why is it so low?
25-45%
No effective screening method for ovarian cancer
Where are ovarian tumors most likely to arise?
65-90% from surface epithelium on the ovarian capsule
Germ cells, stroma are less common
Where are metastatic tumors to the ovary likely to come from?
GI tract - Krukenberg tumors
Breast, endometrium
How does ovarian cancer spread?
Direct exfoliation of cells from the ovary
What can occur in the GI tract with advanced ovarian disease?
Carcinomatous ileus - intraperitoneal tumor spread causes ascites and encasement of bowel with tumor
Leads to malnutrition, starvation, cachexia, death
How is ovarian cancer thought to arise?
Malignant transformation of ovarian tissue after prolonged periods of chronic uninterrupted ovulation
What is the new theory on how ovarian cancer arises?
Thought that it arises from the fallopian tube
What are the odds of developing ovarian cancer with BRCA 1 and 2?
BRCA1 - 30-50%
BRCA2 - 25%
What are risk factors for ovarian cancer?
Uninterrupted ovulation, increasing age
What are protective factors for ovarian cancer?
Ovulation suppression - OCPs, breast feeding, multiparity, chronic anovulation
Tubal ligation and hysterectomy* - thought to be due to decreased migration of carcinogens from lower GI tract up to ovaries
What are the signs and symptoms of ovarian cancer?
Asymptomatic Vague, nonspecific complaints Lower abdominal pain Early satiety Fatigue Urinary frequency N/V Ascites/SOB
What can you see on physical exam with ovarian tumor?
Solid, fixed, irregular pelvic mass
Mets to the umbilicus can result in Sister Mary Joseph nodule
How is ovarian cancer diagnosed?
Pelvic US
CT/MRI for spread of disease
Barium enema and IVP to rule out primary sources
What should not be done for evaluation of ovarian cancer?
Paracentesis and cyst aspiration because it spreads through direct exfoliation
What are tumor markers for ovarian cancer?
CA-125, AFP, LDH, and hCG
How is ovarian cancer staged?
Surgical staging
TAH/BSO, omentectomy, peritoneal washings, sampling of pelvic/para-aortic lymph nodes
What is the most common type of epithelial ovarian tumor?
Serous cystadenocarcinoma - large, cystic, bilateral
What is the treatment of epithelial ovarian cancer ?
Surgery + combination chemo with carboplatin and paclitaxel + intraperitoneal cisplatin and paclitaxel
Follow with Ca-125 levels
What are the characteristics of germ cell ovarian tumors?
95% benign, most commonly benign cystic mature teratoma (dermoid)
grow rapidly
unilateral
curable
What is the treatment for dermoid cysts?
cystectomy because it has 1-2% chance of being malignant
What are the most common malignany germ cell ovarian tumors?
Dysgermimomas
immature teratomas
endodermal yolk sac tumors
choriocarcinoma
What serum tumor markers can be seen in germ cell ovarian tumors?
Dysgermimoma - LDH
Yolk sac - AFP
Choriocarcinoma - hCG
Undifferentiated carcinoma = AFP and hCG
What is the most common ovarian malignancy in women
Germ cell tumors
What are the typical signs of germ cell tumors?
Pelvic mass and abdominal pain
Pressure symptoms
What is the treatment for ovarian germ cell tumors?
Unilateral salpingo-oophorectomy
TAH/BSO if bilateral or childbearing complete
Multiagent chemotherapy (BEP) typically required except for stage Ia dysgermimoma and immature teratomas
What are the types of sex-cord stromal tumors?
Granulosa-theca cell tumors resemble ovaries - produce estradiol and inhibin A/B
Sertoli-Leydig tumors resemble testes - produce testosterone
Ovarian fibroma = not functional, occasionally associated with ascites
What is Meigs syndrome?
Triad of ovarian tumor, ascites, right hydrothorax
What histologic finding is pathognomonic for granulosa cell tumors?
Call-Exner bodies (grooved coffee-bean nuclei, cells arranged around central cavity)
What are the consequences of granulosa cell tumors?
Endometrial hyperplasia/cancer due to estrogen production
What are the signs/symptoms of sertoli-leydig tumors?
Virilization and hirsutism
What is the treatment for sex cord stromal tumors?
Usually unilateral so unilateral SO
TAH/BSO for women past childbearing
Is chemotherapy and radiation useful for sex cord stromal tumors?
No
What are the signs and symptoms of fallopian tube cancers?
Asymptomatic
profuse watery discharge, pelvic pain, pelvic mass - Latzko’s triad (pathognomonic but seen rarely)
What is treatment for fallopian tube cancers?
Same as epithelial ovarian cancer
TAH/BSO, omentectomy, etc
Carboplain and paclitaxel
CA-125 measurements
What is the 5-year survival rate for epithelial ovarian cancer?
20%
