Ovarian and Fallopian Tube Tumors Flashcards

1
Q

What is the 5 year survival for ovarian cancer and why is it so low?

A

25-45%

No effective screening method for ovarian cancer

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2
Q

Where are ovarian tumors most likely to arise?

A

65-90% from surface epithelium on the ovarian capsule

Germ cells, stroma are less common

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3
Q

Where are metastatic tumors to the ovary likely to come from?

A

GI tract - Krukenberg tumors

Breast, endometrium

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4
Q

How does ovarian cancer spread?

A

Direct exfoliation of cells from the ovary

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5
Q

What can occur in the GI tract with advanced ovarian disease?

A

Carcinomatous ileus - intraperitoneal tumor spread causes ascites and encasement of bowel with tumor
Leads to malnutrition, starvation, cachexia, death

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6
Q

How is ovarian cancer thought to arise?

A

Malignant transformation of ovarian tissue after prolonged periods of chronic uninterrupted ovulation

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7
Q

What is the new theory on how ovarian cancer arises?

A

Thought that it arises from the fallopian tube

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8
Q

What are the odds of developing ovarian cancer with BRCA 1 and 2?

A

BRCA1 - 30-50%

BRCA2 - 25%

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9
Q

What are risk factors for ovarian cancer?

A

Uninterrupted ovulation, increasing age

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10
Q

What are protective factors for ovarian cancer?

A

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

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11
Q

What are the signs and symptoms of ovarian cancer?

A
Asymptomatic
Vague, nonspecific complaints
Lower abdominal pain
Early satiety
Fatigue
Urinary frequency
N/V
Ascites/SOB
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12
Q

What can you see on physical exam with ovarian tumor?

A

Solid, fixed, irregular pelvic mass

Mets to the umbilicus can result in Sister Mary Joseph nodule

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13
Q

How is ovarian cancer diagnosed?

A

Pelvic US
CT/MRI for spread of disease
Barium enema and IVP to rule out primary sources

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14
Q

What should not be done for evaluation of ovarian cancer?

A

Paracentesis and cyst aspiration because it spreads through direct exfoliation

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15
Q

What are tumor markers for ovarian cancer?

A

CA-125, AFP, LDH, and hCG

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16
Q

How is ovarian cancer staged?

A

Surgical staging

TAH/BSO, omentectomy, peritoneal washings, sampling of pelvic/para-aortic lymph nodes

17
Q

What is the most common type of epithelial ovarian tumor?

A

Serous cystadenocarcinoma - large, cystic, bilateral

18
Q

What is the treatment of epithelial ovarian cancer ?

A

Surgery + combination chemo with carboplatin and paclitaxel + intraperitoneal cisplatin and paclitaxel
Follow with Ca-125 levels

19
Q

What are the characteristics of germ cell ovarian tumors?

A

95% benign, most commonly benign cystic mature teratoma (dermoid)
grow rapidly
unilateral
curable

20
Q

What is the treatment for dermoid cysts?

A

cystectomy because it has 1-2% chance of being malignant

21
Q

What are the most common malignany germ cell ovarian tumors?

A

Dysgermimomas
immature teratomas
endodermal yolk sac tumors
choriocarcinoma

22
Q

What serum tumor markers can be seen in germ cell ovarian tumors?

A

Dysgermimoma - LDH
Yolk sac - AFP
Choriocarcinoma - hCG
Undifferentiated carcinoma = AFP and hCG

23
Q

What is the most common ovarian malignancy in women

A

Germ cell tumors

24
Q

What are the typical signs of germ cell tumors?

A

Pelvic mass and abdominal pain

Pressure symptoms

25
Q

What is the treatment for ovarian germ cell tumors?

A

Unilateral salpingo-oophorectomy
TAH/BSO if bilateral or childbearing complete

Multiagent chemotherapy (BEP) typically required except for stage Ia dysgermimoma and immature teratomas

26
Q

What are the types of sex-cord stromal tumors?

A

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

27
Q

What is Meigs syndrome?

A

Triad of ovarian tumor, ascites, right hydrothorax

28
Q

What histologic finding is pathognomonic for granulosa cell tumors?

A

Call-Exner bodies (grooved coffee-bean nuclei, cells arranged around central cavity)

29
Q

What are the consequences of granulosa cell tumors?

A

Endometrial hyperplasia/cancer due to estrogen production

30
Q

What are the signs/symptoms of sertoli-leydig tumors?

A

Virilization and hirsutism

31
Q

What is the treatment for sex cord stromal tumors?

A

Usually unilateral so unilateral SO

TAH/BSO for women past childbearing

32
Q

Is chemotherapy and radiation useful for sex cord stromal tumors?

A

No

33
Q

What are the signs and symptoms of fallopian tube cancers?

A

Asymptomatic

profuse watery discharge, pelvic pain, pelvic mass - Latzko’s triad (pathognomonic but seen rarely)

34
Q

What is treatment for fallopian tube cancers?

A

Same as epithelial ovarian cancer
TAH/BSO, omentectomy, etc
Carboplain and paclitaxel
CA-125 measurements

35
Q

What is the 5-year survival rate for epithelial ovarian cancer?

A

20%