Ovarian Cancer Flashcards
What are the histological types of Ovarian cancer?
1) Epithelial tumors
2) Sex cord stromal tumors
3) Germ cell tumors
What is the most common histological type of Ovarian cancer?
Epithelial tumors
What is the rarest histological type of Ovarian cancer
Germ cell tumors
What is the lifetime risk of developing Epithelial Ovarian Cancer with BRCA 1 mutation?
50%
What is the lifetime risk for developing Epithelial Ovarian Cancer with BRCA 2 mutation?
30%
What is the lifetime risk for developing Epithelial Ovarian Cancer with Lynch 2 Syndrome mutation?
10%
What is another name for Lynch 2 Syndrome?
Hereditary Nonpolyposis Colorectal Cancer (HNPCC)
When do we genetic testing for mutations that → Ovarian Cancer?
1) Early onset Breast or Ovarian cancer (i.e., under 40/50 years old)
2) Family history of early onset Breast or Ovarian cancer
3) Women with high grade serous cancer
why do we do genetic testing for Ovarian cancer?
To trace other family members
What genetic mutations are associated with Epithelial Ovarian Cancer?
1) BRCA 1
2) BRCA 2
3) Lynch 2 Syndrome
What do you offer women with BRCA mutation?
Risk-reducing Bilateral Salpingo - Oophorectomy (BSO), between the ages of 35 & 40 or earlier if family complete
What do you offer women with Lynch 2 Syndrome mutation?
Risk- reducing Total Abdominal Hysterectomy & Bilateral Salpingo - Oophorectomy (TAH-BSO)
What are the most common presenting complaints in a patient suspected of Ovarian Cancer?
1) Asymptomatic in earlier stages
2) Pelvic & / or Abdominal pain
3) Non-specific GI symptoms
4) Metastatic signs & symptoms
5) P/V bleeding
6) Rectal bleeding
Why would a patient with Ovarian Cancer complain of dyspnea?
The dyspnea could be due to:
1) Ascites (pushing the diaphragm up)
OR
2) Pleural Effusion
What are the Non-specific GI complaints in a patient suspected of Ovarian Cancer?
♦ Dyspepsia
♦ Bloating
♦ Diarrhea & / Constipation
♦ Urinary frequency / urgency
♦ Weight loss
♦ Early satiety
♦ Nausea & vomiting
♦ Fatigue
♦ Dyspnea
What are the Metastatic signs & symptoms
♦ Brain: Headaches, Seizures, Focal motor deficits
♦ Lymph nodes: Supraclavicular or Inguinal lymphadenopathy
♦ Lungs: Cough, Hemoptysis, Chest pain
♦ Liver: Jaundice, Ascites
♦ Omentum: Abdominal pain (due to infiltration of omental fat)
♦ Bone: Local pain & swelling, Pathological fractures
What signs you should be looking for in an Abdominal exam?
♦ Abdominal distension
♦ Fluid thrill → Ascites
♦ Pelvic lump
- nontender & fixed
♦ Lymph node mass
What signs you should be looking for in a PV exam?
♦ Fullness in the fornices → Ascites
♦ Lump in the fornices
♦ Uterus feels separate from mass
Pain in advance ovarian cancer can radiate where? and why?
Knee joint due to irritation of the obturator nerve
For Ovarian Cancer, what questions should I ask in my HPC?
1) Do these symptoms occur more than 12 times a month?
Ans: most women with ovarian cancer have these symptoms for months
2) Have you ever felt a lump in your pelvis?
Ans: Adnexal mass increases the likelihood of cancer in postmenopausal women
What is Dyspepsia?
Epigastric pain or burning that last for 1 month or more
What symptoms are
associated Dyspepsia?
♦ Heartburn
♦ Nausea
♦ Regurgitation
♦ Bloating
♦ Belching
Note : Dyspepsia & Heartburn maybe indistinguishable
For a Ovarian Cancer, what questions should I ask in my Past Medical Hx?
H/o HRT ?
H/o OCP use ?
H/o fertility medication use ?
What lab investigations should be done in suspicion for Ovarian Cancer?
1st check CA-125 levels
- if more than 35 IU/mL order → TVUS or Abdominal U/S (if mass extends beyond pelvis or there are adhesions)
♦ Blood Tumor marker tests for:
postmenopausal women, check:
1) CA-125
2) Inhibin
for women under 40 check:
1) CA-125
2) Inhibin
3) Alpha fetoprotein (AFP)
4) Lactate dehydrogenase (LDH)
5) β hCG
Routine pre-operative labs:
♦ Baseline CBC
♦ LFTs
♦ U&E
♦ Creatinine
♦ ECG
What are the types of Germ cell tumors?
1) Dysgerminoma
2) Teratoma
3) Endodermal sinus tumor
4) Choriocarcinoma
What are the types of Teratoma
1) Immature
2) Mature
What is another name for a mature teratoma
Dermoid cyst
Which Teratoma is malignant?
Immature
Which type of Teratoma is benign?
Dermoid cyst / Mature Teratoma
What are the types of Epithelial Ovarian Cancer?
1) Serous carcinoma
2) Clear cell carcinoma
3) Endometrioid tumors
4) Mucinous tumors
5) Borderline tumors
6) Mixed cell tumors
What is another name for a Borderline ovarian tumor?
Brenner ovarian tumor OR Transitional cell ovarian tumor
What is the most common type of Epithelial Ovarian Cancer?
Serous carcinoma
What is the 2nd most common type of Epithelial Ovarian Cancer?
Endometrioid tumors
What is the least common type of Epithelial Ovarian Cancer?
1) Clear cell carcinoma
2) Mucinous tumors
3) Borderline tumors
4) Mixed cell tumors
How do you estimate the risk of malignancy in ovarian masses?
1) Risk of Malignancy Index (RMI)
2) International Ovarian Tumor Analysis (IOTA) ultrasound rules
When calculating the RMI score what formula is used?
RMI = CA-125 x U x M
CA-125 - units must be IU/mL
