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OB/GYN Boards by Subject > Ovarian cancer > Flashcards

Ovarian cancer Flashcards

1
Q

Proportion of GYN cancer that is ovarian and proportion of GYN cancer deaths that are ovarian.

A

25% / 50%

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2
Q

Lifetime risk of ovarian cancer for average woman

A

1:70

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3
Q

Percent of ovarian cancers of each type

A

Epithelial 85%
Germ cell 10%
Sex cord stromal 5%

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4
Q

Risk factors for ovarian cancer (5)

A
  1. Early menarche
  2. Late menopause
  3. Ovulation induction agents
  4. Environmental factors? (talc, asbestos)
  5. Genetics
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5
Q

Protective factors against ovarian cancer (5)

A
  1. OCPs
  2. Pregnancy
  3. Breastfeeding
  4. Tubal ligation
  5. Hysterectomy
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6
Q

Genetic syndromes related to ovarian cancer (3)

A

BRCA1, BRCA2, Lynch II

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7
Q

Chromosomes of BRCA mutations

A 
BRCA1 = chromosome 17
BRCA2 = chromosome 13
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8
Q

Risk of ovarian cancer with each BRCA mutation

A

BRCA1 50%

BRCA2 25%

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9
Q

Risk of breast cancer with each BRCA mutation

A

BRCA1 60-90%

BRCA2 60-90%, also male breast cancer increased

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10
Q

Mutations of Lynch (HNPCC)

A

MSH2 or MLH1

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11
Q

Cancers caused by Lynch (HNPCC)

A

Colon (most common, proximal colon)
Endometrial
Stomach, small intestine, ovary, urinary tract, bile duct, etc.

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12
Q

Only way to make definitive diagnosis of ovarian cancer

A

Surgical USO

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13
Q

Size concerning for ovarian malignancy pre- and post-menopausal

A

> 8 cm premenopausal

>5 cm postmenopausal

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14
Q

CA125 concerning in premenopausal woman

A

> 200

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15
Q

Most common histology of epithelial ovarian cancer

A

Serous (50-60%)
Endometrioid (20%)
Mucinous (15%)
Clear cell (5%)

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16
Q

FIGO staging of ovarian cancer by location

A

Stage I - ovary
Stage II - pelvis
Stage III - abdomen and retroperitoneum
Stage IV - distant

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17
Q

Stage I

A 
IA - unilateral
IB - bilateral
IC1 - surgical spillage
IC2 - capsule rupture prior to surgery
IC3 - positive washings
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18
Q

Stage II

A

IIA - tube or uterus

IIB - other pelvic or peritoneal extension

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19
Q

Stage III

A

IIIA1 - retroperitoneal LNs
IIIA2 - microscopic extrapelvic spread
IIIB - visible but <2 cm
IIIC - >2 cm

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20
Q

Stage IV

A

IVA - pleural effusion with cytology pos

IVB - parenchymal mets to liver, spleen, or extra-abdominal organs (including inguinal LNs)

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21
Q

Percent of ovarian cancer found stage III-IV

A

70-80%

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22
Q

Treatment stage IA to IB

A

Fertility preservation at staging acceptable, no further treatment

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23
Q

Treatment stage IC

A

Adjuvant chemo (carbo/taxol)

24
Q

Treatment stage II-III

A

Cytoreductive surgery, adjuvant chemo (carbo/taxol, taxol/platinum)

25
Q

Treatment stage IV

A

Neoadjuvant chemo (carbo/taxol), then cytoreductive surgery

26
Q

“Optimal cytoreduction”

A

<1 cm residual nodule

27
Q

Recurrence treatment

A

Secondary cytoreductive surgery if >6 mos since treatment

Otherwise, second-line chemotherapy (can also do for later recurrence)

28
Q

Most common tumor type on first two decades of life

A

Germ cell tumor (70%)

29
Q

Follow-up after remission

A

Physical exam q3 mos x 5 yrs
CA125 q3mos
CT q6mos

30
Q

Categories of germ cell tumors

A
  1. Benign (mature teratoma)
  2. Malignant arising from constituents of dermoids (squamous, struma ovarii)
  3. Primitive malignant GCTs (dysgerminoma, yolk sac, immature teratoma, choriocarcinoma, embryonal carcinoma, polyembriomas, mixed)
31
Q

Proportion of dermoids that are bilateral

A

12%

32
Q

1% of all dermoids for patients >40 y/o contain this type of malignancy

A

Squamous cell carcinoma

33
Q

LDH

A

Dysgerminoma

34
Q

Alpha-fetoprotein

A

Endodermal sinus (yolk sac) tumor

35
Q

Beta hcg

A

Choriocarcinoma

36
Q

GCT likely to be caught during pregnancy

A

Dysgerminoma (15%)

37
Q

Malignancy likely to occur in dysgenetic ovary (46XY or mosaic)

A

Dysgerminoma -> gonadoblastoma

38
Q

Schiller-Duvall bodies

A

Endodermal sinus (yolk sac) tumor - cross-section of single papilla with a central vessel surrounded by tumor cells

39
Q

Grading of immature teratoma based on…

A

Amount of neural element

40
Q

Most common mixed GCT

A

Dysgerminoma

41
Q

Treatment for germ cell tumors

A

USO, chemo (bleomycin, etoposide, cisplatin = BEP)

42
Q

Only germ cell tumor that is radiation sensitive

A

Dysgerminoma

43
Q

Sex cord cells

A

Granulosa, Sertoli

44
Q

Mesenchymal (stromal) cells

A

Theca, Leydig, fibroblasts

45
Q

Proportion of malignant ovarian tumors that are sex cord stromal

A

5%

46
Q

Age distribution for sex cord stromal

A

Many <40 y/o but does continue to increase over age

47
Q

Meig’s syndrome

A

Fibroma + pleural effusion

48
Q

Call-Exner bodies

A

Granuloma cell tumor - cavities filled with fluid or basement membrane material

49
Q

Coffee bean nuclei

A

Granulosa cell tumor - oval, grooved

50
Q

Most common sex cord stromal tumor

A

Granulosa cell tumor

51
Q

2 types of granulosa cell tumor

A

Adult or juvenile (adult = 95%)

52
Q

Prognosis of granulosa cell tumor

A

90% are found stage I
10 yr survival 90%
Indolent growth, so late recurrence

53
Q

Juvenile granulosa cell tumor prognosis if caught late

A

Poor, aggressiveif found advanced

54
Q

Syndromes associated with juvenile granulosa cell tumor

A

Ollier’s disease - enchondromatiosis

Maffucci’s syndrome - ^ + hemangiomas

55
Q

Sex cord stromal with annular tubules

A

Association with Peutz-Jegher (36%) - occurs in 4th decade of life and tend to be benign
Without PJS - occurs in 3rd decade of life, large and palpable, 20% malignant

OB/GYN Boards by Subject (22 decks)

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