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FRANZCOG Gynaecology > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

1
Q

EOC per 100,000

a) Mortality rate
b) age standardised incidence

A

a) 7.4

b) 12.6

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2
Q

Lifetime risk of being diagnosed with ovarian cancer

A

1-1.5%

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3
Q

Risk of ovarian malignancy based on RMI?

A 
<25 = <3%
25-250 = 20%
>250 = 75% (sens 70%, spec 90%)

cut off 200 increased sensitivity (78%, 87%)

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4
Q

Most common type of epithelial ovarian cancer?

A

serous cystadenocarcinoma

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5
Q

Proportion of EOC caused by endometriod cell carcinoma?

A

10%

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6
Q

What type of cell is Brenne’s cell tumor derived from?

A

Transitional cell

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7
Q

Clear cell carcinoma is derived from what type of cell?

A

Mullerian

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8
Q

Normal ovarian volume in pre and post-menopausal women?

A

<20cm3 premenopausal

<10cm3 postmenopausal

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9
Q

List 7 criteria for a screening programme

A
  1. Condition: suitable for screening
  2. Test: suitable
  3. Treatment: effective + accessable
  4. Mortality/Morbidity reduced
  5. Benefit>Harm
  6. Sustainable
  7. Social/Ethics/Cost considered
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10
Q

Proportion of ovarian cancer diagnosed in late stages?

A

75%

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11
Q

Inheritance of BRCA?

A

Chromosome 17

Autosomal dominant

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12
Q

BRCA 1 80y cumulative risk

a) breast cancer
b) ovarian cancer

A

a) 72%

b) 44%

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13
Q

BRCA 2 80y cumulative risk

a) breast cancer
b) ovarian cancer

A

a) 69%

b) 17%

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14
Q

Frequent histological finding of serous tumor?

A

psammoma bodies

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15
Q

Tumor marker secreted by serous EOC?

A

Ca125

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16
Q

Risk factors for serous ovarian cancer?

A 
caucasian
nulliparous
chronic ovulator
nil COCP
HRT
Fanconi
Ashkenazi Jew
Icelandic
BRCA hx
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17
Q

Common USS findings serous ovarian cancer?

A

mixed solid/cystic
thick septations
calcification uncommon
frequently bilateral

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18
Q

Most important prognostic factor of serous adenocarcinoma?

A

stage at diagnosis

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19
Q

High grade serous ovarian cancer 5yr survival?

A

40%

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20
Q

Low grade serous ovarian cancer 5 year survival, advanced stage.

A

80%

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21
Q

Epithelial ovarian cancer low grade, early stage- should they receive chemotherapy?

A

No- does not improve survival.

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22
Q

Ca125 is elevated in what types of ovarian cancer?

A

80% of EOC, particularly non-mucinous tumors.

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23
Q

Mucinous tumors have elevation of what markers?

A

CEA, Ca199, +/- Ca125

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24
Q

Histology difference borderline vs. malignant mucinous tumor

A

> 10mm2 stromal invasion = malignant

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25
Q

Grading mucinous tumors is dependent on what histological features?

A

% of solid component

Grade I= no solid
Grade II= <50% solid
Grade III = >50% solid

severe nuclear atypic can increase the grade

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26
Q

Mean age of diagnosis of mucinous adenocarcinoma of ovary?

A

60yo

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27
Q

Mucinous adenocarcinoma of the ovary is confirmed to the ovary in what proportion of cases?

A

95-98%

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28
Q

Proportion of mucinous adenocarcinoma found in ovary that is primary vs. secondary?

A

primary ~20%

secondary ~80%

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29
Q

USS appearance of mucinous cystadenocarcinoma

A

mural thickening
solid/cystic components
95% unilateral
areas of haemorrhage

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30
Q

MRI T1 appearance of mucinous cystadenocarcinoma

A

mucin = higher signal than water

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31
Q

Prognosis of stage I mucinous adenocarcinoma?

A

95%

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32
Q

Prognosis mucinous cystadenocarcinoma stage II or worse?

A

32%

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33
Q

Clear cell carcinoma histology of cells?

A

hobnail

clear

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34
Q

Risk factors for clear cell carcinoma of the ovary?

A 
Lynch Syndrome
Endometriosis
Family history of ovarian cancer
chronic ovulates (early menarche, late menopause, no COCP)
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35
Q

Most common type of tumor to be associated with paraneoplastic syndromes?

A

Clear cell ovarian cancer

36
Q

USS findings clear cell ovarian cancer?

A

unilocular
cystic
smooth
highly attenuated cystic portion

37
Q

Prognosis 5yr stage I-IV clear cell carcinoma?

A 
I = 85%
II = 71%
III= 35%
IV= 16%
38
Q

Oopherectomy with this type of EOC is usually curative…

A

Brenner’s

39
Q

6 types of sex-cord stromal ovarian cancer?

A
  1. Granulosa-stromal
  2. Androblastoma
  3. Gynandroblastoma
  4. Sex-cord tumor annular tubules
  5. Sex-cord stromal tumors NOS
  6. Steroid cell tumors
40
Q

These tumors account for 70% of sex-cord stromal malignancies…

A

Granulosa-Stromal Cell Tumors

41
Q

Ovarian tumor that can present with abnormal uterine bleeding?

A

Granulosa-stromal tumor

42
Q

Ovarian tumor presenting with oligo/amonorrhoea?

A

Sertoli-Leydig cell tumor

43
Q

Three classes of germ cell ovarian cancer

A
  1. Primitive germ cell
  2. Biphasic/triphasic teratoma
  3. Monodermal teratoma and somatic type tumor associated with dermoid cysts
44
Q

Types of ovarian cancer associated with elevated bhcg?

A

choriocarcinoma, embryonal, polyembryoma

45
Q

Type of ovarian cancer associated with elevated AFP?

A

yolk sac

sometimes embryonal or polyembryoma

46
Q

Ovarian cancer with elevated LDH

A

dysgerminoma

47
Q

Most common type of ovarian germ cell cancer?

A

dysgerminoma (30-40%)

48
Q

Elevated calcium and ovarian mass. Differentials?

A

Clear cell carcinoma
Metastatic disease
Dysgerminoma

49
Q

Proportion of ovarian cancer caused by immature teratoma?

50
Q

Most common type of malignancy initially developing within immature teratoma’s?

51
Q

Proportion of ovarian germ cell tumors caused by yolk sac carcinoma?

52
Q

Hormones commonly secreted by granuloma-stromal cell malignancy?

A

estrogen or androgens

53
Q

Types of ovarian cancer causing virilisation?

A

Sertoli-Leydig

54
Q

Proportion of ovarian cancer associated with familial/genetic predisposition?

55
Q

Immunohistochemistry for serous ovarian cancers if

a) low grade
b) high grade

A

a) KRAS/BRAF, often has borderline components

b) TP53 mutations and BRCA abnormalities

56
Q

Recommended treatment for high and low grade serous ovarian cancer?

A

High grade

  • hysterectomy, debulking, BSO, staging biopsies
  • chemotherapy (adjuvant, neoadjuvant)

Low grade

  • hysterectomy, debulking, lymph node biopsy, BSO
  • adjuvant chemotherapy only if spread or advanced stage

Preferred chemo is carboplatin and paclitaxel

57
Q

Preferred management of mucinous EOC?

A
  1. aim for complete surgical resection
  2. appendicectomy
  3. advanced stage disease often treated with adjuvant platinum based chemotherapy (low efficacy compared to serous)
  4. molecular therapies under development.
58
Q

Treat meant for endometriod EOC?

A
  • surgery for early stage cancers
  • adjuvant chemotherapy is associated with survival benefit for patients with grade 2 stage I cancers.
  • platinum based chemotherapy may benefit those with advanced stage disease (III, IV)
59
Q

Treatment for clear cell EOC?

A
  • Hysterectomy, bilateral salpingo-oopherectomy, omentectomy, staging biopsies
  • Adjuvant chemoradiation in some patients (platinum resistant)
60
Q

Positive prognostici factors for clear cell carcinoma?

A
  • stage is most important
  • positive lymph nodes
  • LVSI
  • positive prognostic factor PIK3CA mutation
61
Q

5yr prognosis for Stage I-IV clear cell carcinoma?

A 
I = 85%
II= 71%
III = 35%
IV = 16%
62
Q

RMI calculation (RCOG)

A

RMI = U x M x Ca125

U= point for multilocular, solid, metastases, ascites, bilateral
0 = 0, 1 = 1, If 2 or more = 3

M = 1 = premenopausal, 3 = postmenopausal

63
Q

Sensitivity and specificity of RMI of 200 (RCOG)

A

78% sens

87% specific

64
Q

Management of asymptomatic, unilateral, unilocular cyst of <5cm in postmenopausal women? (RCOG)

A

Ca125

If normal repeat evaluation in 4-6 months.

65
Q

At what size should an ovarian cyst in a postmenopausal woman be investigated with a USS and Ca125? (RCOG)

66
Q

At what cyst size should bilateral sapling-oopherectomy be offered in a postmenopausal woman? (RCOG)

67
Q

When should CT AP be performed for an ovarian cyst? (RCOG)

68
Q

Ovarian cyst, RMI >200, CT AP performed, MDT review and felt to be low risk. What would be the recommended surgical management? (RCOG)

A

Pelvic clearance (TAH + BSO + omentectomy + peritoneal cytology) by a suitably trained gynaecologist

69
Q

RCOG recommendations for genetic screening for BRCA? (RCOG)

A
  • high grade or invasive EOC
  • EOC + 1x family member

Ovarian/Breast Cancer
First degree relative of you + first degree relative of them

  • 1x OC + 1xBC <50yo
  • 1x OC + 2BC <60yo
  • 1x BC +OC (one person, both ca)

Colorectal cancer

  • 3x CRC
  • 2x CRC + 1x stomach/ovarian/urinary/endoetrial/small bowel. At least one <50yo.
70
Q

Recommendations around fertility preservation with ovarian cancer? (O+G Mag)

A

Oocyte cryopreservation
- 3000 babies born worldwide
- available in NZ for women >16yo, <40yo
- storage for a maximum of 10 years
- use later on only funded if woman/partner proven infertility, <40yo, BMI <32, nonsmoker, no children.
- must use ICSI due to hardening of zone pellucida
live birth rates per oocyte 7.5-10% <30yo, 7-7.5% <35yo

Ovarian preservation

  • not funded NZ
  • reimplanted with restoration of hormonal function.
  • 47.6% conceived at least once (50% naturally)
71
Q

Ovarian cancer screening in high risk women? (O+G mag)

A

TVUSS and Ca125 lack sufficient sensitivity and specificity
One study did four monthly=
- more diagnosed at earlier stages
- no proven improvement in mortality

Current guidelines say no.

72
Q

Non surgical prevention of ovarian cancer in BRCA carriers?

O&G mag

A

less effective than surgical prevention (98%)
COCP can prevent, not as effective (50%)
No data on implant or mirena
small increased risk of breast ca in mirena users.
Await results of trial looking at aspirin use.

Hysterectomy with BSO- individualised.

  • no data re increased risk endometrial Ca. Maybe greater proportion serous histo.
  • may aid MHT (by permitting oestrogen-only MHT), or the use of Tamoxifen for breast cancer chemoprevention/adjuvant treatment of breast cancer
73
Q

Overall incidence of a malignant symptomatic ovarian cyst in a premenopausal female?

74
Q

proportion of ovarian masses that are found to be non-ovarian in origin?

75
Q

Sensitivity of clinical examination in detection of ovarian masses?

76
Q

What tumor markers should be done in women <40yo?

A

LDH, AFP, hCG, Ca125

77
Q

Management of premenopausal woman with 60mm simple cyst?

A

Yearly USS FU

78
Q

At what size simple cyst should surgical intervention be considered in premenopausal woman?

79
Q

Granulosa cell tumor management?

A

Surgery:
- Stage 1A can perform USO for fertility. Must perform endometrial biopsy.
- ideally TAH + BSO in peri/postmenopausal women
No evidence for radiation or chemotherapy

80
Q

Poor prognostic factors Granulosa cell tumors (4)?

A

advanced stage
poorly differentiated
sarcomatoid
large >15cm

81
Q

Management of Sertoli-leydig ovarian cancer?

A

USO if you/fertility sparing
hysterectomy + BSO if peri/post menopausal
insufficient evidence for chemo or radiation.

82
Q

Most common germ cell ovarian cancer?

A

dysgerminoma.

83
Q

Treatment dysgerminoma?

A

surgical resection, at least unilateral oopherectomy.
chemosensitive with BEP if metastatic disease
sensitive to radiation, but loss of fertility high risk.

84
Q

TVUSS findings of dysgerminoma?

A

large, vascular, solid, lobulated, septae, haemorrhage, necrosis, calcifications

85
Q

Treatment premenopausal immature teratoma?

A
  • Surgery
    • Premenopausal
      • unilateral oopherectomy and surgical staging
      • contralateral ovarian wedge biopsy unnecessary
      • fertility considerations
  • Chemotherapy
    • Recommended for high grade lesions (2 or 3)
    • Patients with stage I grade I tumors only require surveillance
    • BEP is chemotherapy regime.

FRANZCOG Gynaecology (14 decks)

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