Ovarian cancer

Question 1

STAGE I :

Answer 1

Limited to one or both ovaries

Question 2

IA

Answer 2

Involves one ovary; capsule intact; no tumor on ovarian surface; no malignant cells in ascites
or peritoneal washings

Question 3

IB

Answer 3

Involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings

Question 4

IC1

Answer 4

surgical spill

Question 5

IC2

Answer 5

capsule ruptured or tumor on ovarian surface

Question 6

IC3

Answer 6

malignant cells in ascetic fluid or positive washings

Question 7

II

Answer 7

Tumor involves one or both ovaries with Pelvic extension( below pelvic brim) or Primary
Peritoneal cancer

Question 8

IIA

Answer 8

Extension or implants onto uterus or fallopian tube

Question 9

IIB

Answer 9

Extension or implants onto other pelvic structures

Question 10

III

Answer 10

tumor involves one/ both ovaries with cytological or histologically confirmed spread to
peritoneum outside of the pelvis and/or metastasis to the retroperitoneal LN

Question 11

IIIA

Answer 11

retroperitoneal LN only( CYTOLOGICALY /HISTOLOGICALY PROVED)

Question 12

IIIA1

Answer 12

• Positive retroperitoneal LN
  IIIA1(i) – mets < equal to 10mm
  IIIA(ii)- mets > 10 mm

Question 13

IIIA2

Answer 13

microscopic, extrapelvic (above pelvic brim ) , peritoneal involvement +/- positive retroperitoneal LN

Question 14

IIIB

Answer 14

Macroscopic extrapelvic peritoneal metastases beyond pelvis < or equal to 2 cm in size +/- positive
retroperitoneal LN

Question 15

IIIC

Answer 15

Peritoneal metastases beyond pelvis >2 cm or lymph node metastases LN (includes extension to capsule of
liver or spleen without paranchymal involvement of either organ)

Question 16

IV

Answer 16

Distant metastases – in the liver, or outside the peritoneal cavity

Question 17

IVA

Answer 17

plueral effusion with positive cytology

Question 18

IVB

Answer 18

hepatic/splenic parenchymal mets, metastasis to extra-abdominal organs
(involving inguinal LN and LN outside the abdominal cavity)

Question 19

Fertility sparing surgery

Answer 19

STAGE Ia well-differentiated tumours ( Grade 1, possiblly grade 2 of
serous/mucinous and endometriod type):- U/L Salpingo-oopherectomy + Omentectomy+ peritoneal sampling
para-colic and sub-diaphragmatic b/l + LN assessement and removal.

Question 20

ADJUVANT CHEMOTHERAPY:-
 Stage Ia-Ib well-differentiated tumours ( Grade 1 and grade 2)

Answer 20

not offered adjuvant
chemotherapy

Question 21

Adjuvant chemo Stage Ia, Ib ( grade 3) and Stage Ic, clear cell subtypes

Answer 21

3- 6 cycles of single agent chemotherapy
every 3 weeks – CARBOPLATIN.

Question 22

Adjuvant chemo Stage II

Answer 22

carboplatin + paclitexal 6 cycles

Question 23

Interval debulking

Answer 23

ADVANCED 3C AND BEYOND
Neoadjuvant CT ( 3cycles) f/b Surgery f/b rest 3 cycles of CT. Both regimens are administered every three
weekly for six cycles

Question 24

Tissue biopsy

Answer 24

important for diagnosis
Use cytology together with CA-125/CEA >25:1 in patients if histology is not appropriate

Question 25

Platinum sensitive (PS)

Answer 25

progress with interval of > 6 months after completion of CT

Question 26

Platinum resistant

Answer 26

progress with interval of <6 months after completion of CT.

Question 27

Platinum Refractory

Answer 27

progress during or / within 4 weeks after completion of CT.

Question 28

Carboplatin hypersensitivity

Answer 28

desensitization attempted, or alternatively cisplatin

Question 29

Paclitexal neurotoxicity

Answer 29

Gemcitabine/ liposomal doxorubicin

Question 30

Bevacizumab

Answer 30

added to relapsed platinum-based CT and as maintenance afterwards increase progress free survival, but S/E- HTN/ brain bleed

Question 31

PLATINUM RESISTANT AND PLATINUM REFRACTORY

Answer 31

Second line CT < 10% effective. * No advantage of combination therapy as will only increase side effects. * Single agent PLD / etoposide/ topotecan/ gemcitabine * Addition of Bevacizumab is beneficial

Question 32

CLEAR HOBNAIL CELLS

Answer 32

Clear Cell Carcinoma

Question 33

Endometriod carcinoma of ovary

Answer 33

Second most common  15% EOC  Associated with endometriosis  15% associated with endometrial cancer  Squamous metaplasia is confirmatory  Most frequently associated with endometriosis + hypercalcemis+ VTE

Question 34

ovarian cancer are likely to be hereditary

Answer 34

5-10 %

Question 35

BRCA1 and BRCA2.

Answer 35

These account for ≈ 40–50% of hereditary breast cancer-only families and 95% of families with both breast and ovarian cancer.  Autosomal dominant

Question 36

Cumulative risks for the development of breast/ovarian cancer.  Normal population

Answer 36

breast 10%, ovarian 1.4%, endometrial 1.1%.

Question 37

Cumulative risks for the development of breast/ovarian cancer.BRCA 1

Answer 37

breast 65%, ovarian 20-50%.

Question 38

Cumulative risks for the development of breast/ovarian cancer.BRCA 2

Answer 38

breast 45%, ovarian 10-20% (male breast 6% and prostate cancer)

Question 39

Risk reducing surgery

Answer 39

BILATERAL SALPINGO-OOPHERECTOMY (RR BSO) DONE BY 35- 40 YEARS OR WHEN CHILD BEARING IS COMPLETE.

Question 40

If RR surgery is refused in BRCA 1/2 people

Answer 40

TVS+ CA- 125 EVERY 6 MONTHS STARTING AT 35 YEARS OF AGE OR 5-10 YEARS EARLIER THAN THE EARLIEST AGE OF FIRST DIAGNOSIS OF OVARIAN CANCER IN FAMILY.

Question 41

RR-BSO provides benefit of significantly reducing the risk of Breast Cancer by

Answer 41

30-75%

Question 42

RR Sx Reducing risk of Ovarian Cancer by

Answer 42

80-96%, increasing survival by 60-76%

Question 43

RR BSO is not completely protective carriers still have risk of developing Primary Peritoneal Cancer

Answer 43

2%

Question 44

OCCULT RISK OF MALIGNANCY IN RR-BSO IS

Answer 44

4-20%.  CHANCES ARE 4-8 % WHICH INCREASES TO 20% BY THE AGE OF 45 YEARS.  SO TVS + CA- 125 BEFORE SURGERY ADVICED.

Question 45

)BRCA1 – OFFERED SURGERY ( RR BSO(BY

Answer 45

35 YEARS OR WHEN FAMILY COMPLETED.

Question 46

RR BSO BRCA 2

Answer 46

2-3% INCIDENCE FOR DECADE LATER THAN BRCA1 BY 50 YEARS AND AVERAGE AGE IS SIMILAR TO GENERAL POPULATION THAT IS 60 YEARS- SO THESE PATIENT CAN DELAY SURGERY, BUT THAN BY DELAYING SURGERY THEY WILL NOT BE BENEFFITED BY REDUCTION IN RISK OF BREAST CANCER.

Question 47

OCCULT RISK OF MALIGNANCY IN RR-BSO IS

Answer 47

4-20%.