Ovarian Cancer Flashcards by Katie Clark

Ovarian cysts usually resolve on their own. True/False?

True

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List some common sites of endometriosis

Ovary (chocolate cysts)
Pouch of Douglas
Peritoneum
Cervix, vulva, vagina
Bladder
Bowel

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What is the typical appearance of endometriosis in the ovary? (buzzword)

Chocolate cysts

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List the main epithelial ovarian tumours

Serous
Mucinous
Endometrioid
Clear cell
Brenner

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What is the precursor for high-grade serous carcinoma of the ovary?

Serous tubal intraepithelial carcinoma (STIC)

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Which ovarian cancers are associated with endometriosis?

Endometrioid
Clear cell carcinoma

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Most endometrioid cancer is low-grade. True/False?

True

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What syndrome is associated with endometrioid cancer?

Lynch syndrome

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What is Brenner tumour?

Transitional cell epithelium tumour that is usually benign

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List the main germ cell tumours that can occur the ovary?

Teratoma
Dysgerminomas
Yolk sac tumour
Choriocarcinoma

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What is the most common malignant germ cell tumour? Who does it typically affect?

Dysgerminomas
Children and young woman

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List the main sex cord/stromal tumours

Fibroma/thecoma
Granulosa cell tumour
Sertoli-Leydig cell tumours

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What are the commonest sites that metastasise to the ovary?

Stomach
Colon
Breast
Pancreas

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Describe FIGO stage I of ovarian cancer

IA: one ovary
IB: both ovaries
IC: ovary with rupture/spill

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Describe FIGO stage II of ovarian cancer

IIA: extension to uterus/fallopian tube
IIB: extension to other pelvic intraperitoneal structure

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Describe FIGO stage III of ovarian cancer

IIIA: retroperitoneal lymph node metastasis
IIIB: peritoneal metastasis beyond pelvis up to 2cm
IIIC: peritoneal metastasis beyond pelvic over 2cm

Describe FIGO stage IV of ovarian cancer

IV: distant metastasis

A smear test can pick up ovarian cancer. True/False?

False
1 in 3 believe it does though

Which BRCA mutation (1 or 2) is more associated with ovarian cancer?

BRCA1 (40%)
BRCA2 (18%)

Ovarian cancer often presents early with red flag symptoms. True/False?

False
Prevents late with non-specific symptoms

List some non-specific clinical features of ovarian cancer

Ascites/bloating
Pelvic mass
Bladder dysfunction
Pleural effusion
Breathlessness

Ovarian cancer can commonly be asymptomatic. True/False?

False
Rarely asymptomatic with almost always abdominal bloating/distention

What is the BEAT acronym to help raise awareness for ovarian cancer?

Bloating
Eating less, feeling full
Abdominal pain
Tell GP!

How is ovarian cancer screened for?

It isn’t!
High-risk women are identified and investigated, though

What should we offer women with BRCA mutations?

Prophylactic oophorectomy and removal of fallopian tubes

What marker is used in the diagnosis of ovarian cancer?

CA 125

Raised CA 125 alone is enough to diagnose ovarian cancer. True/False?

False Can be raised in other things (e.g. endometriosis) so need ultrasound or other investigations

What is the gold standard investigation for diagnosing ovarian cancer?

Pathology specimen from CT-guided biopsy or laparoscopic biopsy

State the calculation for "risk of malignancy index" for ovarian cancer

Ultrasound score x menopausal score x CA125 level

How many points on the "risk of malignancy index" for ovarian cancer is enough to refer to secondary care?

Score greater than 200

What are the ultrasound features looked out for in ovarian cancer that are involved in the "risk of malignancy index"?

Multilocular cysts Solid areas Bilateral lesions Ascites Intra-abdominal mass

What are the main methods of metastases of ovarian cancer?

Transcoelomic spread (peritoneal) Haematogenous Lymphatic

List the main treatment options for ovarian cancer

Surgery Chemotherapy + surgery

In advanced ovarian cancer, what should be given prior to surgery?

Neoadjuvant chemotherapy

What are the main chemotherapy agents used for ovarian cancer?

Carboplatin (1st line) Paclitaxel (more side-effects)

What chemotherapy should be offered in those with relapsing platinum-sensitive ovarian cancer?

Platinum-based combination with paclitaxel, PLDH or gemcitabine

What therapy can be used for platinum-resistant ovarian cancer?

Hormonal therapy (tamoxifen, letrozole)

In the absence of symptoms, should CA125 levels be measured during followup for ovarian cancer?

Not routinely monitored as won't benefit with early chemotherapy