Ovarian Cancer Flashcards
Incidence of ovarian cancer with genetic predisposition
10%
How do you reduce the risk of cancer in patients with high risk?
Risk reducing salpingoopherectomy
What is the primary imaging modality for Investigating suspected ovarian cancer
Ultrasound
Ultrasound features inkeeping with malignancy?
M RULES (5)
- irregular solid tumor
- ascites
- atleast 4 papillary structures
- irregular multilocular solid tumor >10cm
- increased vascularity
Other reported ultrasound features of malignancy (elearning)
(5)
- thickened septum (>3mm)
- multilocularity
- solid components/ papillary projections
- bilateral lesions
- ascites or metastatic lesions
ORADS 5 (USA) high risk features (5)
- unilocular cyst with >4 papillary projections
- multilocular cyst with solid component , mod- strong blood flow
- solid (>80%) with smooth contour , very strong flow
- solid with irregular contour
- ascites +/- peritoneal nodules
Stage 1 A
Limited to one ovary with serosa intact. Negative washing
Stage 1B
Both ovaries, capsule intact, negative washing
Stage 1C1
1A or 1B with intraoperative capsule breech
Stage 1C2
Stage 1A or B with Preoperative capsule rupture
1C3
Either 1A or 1B with positive peritoneal washings
Stage 2A
One or both ovaries
Extension or implant on uterus +/- fallopian tubes
Stage 2B
Extension to other pelvic intrapertitoneal tissue
Stage 3A1i
Retroperitoneal nodes <10mm
Stage 3A2
Microscopic extrapelvic Mets +/- retroperitoneal nodes
Stage 3A1ii
Retroperitoneal nodes >10mm
Stage 3B
Macroscopic extrapelvic <2cm +/- retroperitoneal nodes
Stage 3C
Extrapelvic nodes >2cm +/- retroperitoneal nodes
Includes extension to capsule of liver/spleen without parenchymal involvement
Stage 4A
Pleural effusion + cytology
Stage 4B
Hepatic/ spleen parenchyma
Extra abdominal lymph nodes eg inguinal
Associated symptoms (5)
- persistent abdominal bloating
- early satiety
- loss of appetite
- pelvic or abdominal pain
- increased Urinary frequency or urgency
Sensitivity and specificity of ultrasound in postmenopausal ovarian cyst
Sensitivity 89%
Specificity 73%
Risk of ovarian ca with lynch syndrome
12%
Risk of cancer if RMI 25-250
20%
Risk of cancer if RMI >250
> 75%
Germ cell tumors make up what percentage of ovarian tumors
10%
What tumor markers are increased for dysgerminomas (3)
LDH
Alkaline phosphates
Occasionally hcg
What tumor markers is related to endodermal sinus tumor
Alpha feto protein
What tumor markers are associated with embryonic carcinoma (3)
Alpha feto protein
Hcg
Estrogen occasionally
What is the most common germ cell tumor
Dysgerminoma
(Seminoma in males)
What age group is dysgerminoa prevalent in
Young women
60% seen in women <20years
What is the hallmark histological finding of dysgerminomas
Lymphocytic infiltration of the stroma
What is the inheritance pattern if lynch syndrome
Autosomal dominant
What cancers are linked to LYNCH(7)
- colorectal
- endometrial
- ovarian
- gastric
- Urinary tract
- brain
- hepatobiliary
LYNCH
Lifetime risk of colorectal cancer
50-80%
LYNCH
lifetime risk of endometrial ca
40-60%
LYNCH
life time risk if ovarian ca
10-12%
What gene carries an especially high risk of endometrial ca in LYNCH syndrome
MSH 6
What is the risk reduction of BSO in brca positive women
80-96%
What is the risk reduction of mastectomy in BRCA 1 positive
56%
What is the risk reduction with mastectomy in BRCA 2
46%
What is the risk of primary peritoneal cancer
1-6%
When should risk reduction surgery be done for BRCA 1 positive patients
Age 35-40
When should risk reduction be offered for BRCA 2
40 Years
What percentage of patients with granulosa cell tumor have endometrial hyperplasia
1:3
33%
What is the incidence of granulosa cell tumors
10-25%
70% secrete estrogen
