Ovarian Cancer Flashcards by David Houghton

Ovarian cancer is the 5th most common cancer in women. What is the current incidence of this?

1 - 1.2 cases per 100,000
2 - 12 cases per 100,000
3 - 120 cases per 100,000
4 - 1200 cases per 100,000

1 - 1.2 cases per 100,000

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Ovarian cancer is the 5th most common cancer in women. What age does incidence of ovarian cancer peak?

1 - 30-40
2 - 40-50
3 - 60-70
5 - 80-90

3 - 60-70

Age is the biggest risk factor

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Is ovarian cancer more common in white or black women?

white women

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Mutations in which 2 of the following genes are associated with an increased risk in ovarian cancer?

1 - carcinoembryonic antigen (CEA)
2 - carbohydrate antigen-19 (CA-19)
3 - BReast CAncer gene-1 (BRCA-1)
4 - BReast CAncer gene-2 (BRCA-2)

3 - BReast CAncer gene-1 (BRCA-1)
4 - BReast CAncer gene-2 (BRCA-2)

BRCA-1 and 2 are associated with breast and ovarian cancer. Account for aprox 5-15% of ovarian cancers

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Which of the following is NOT a risk factor for developing ovarian cancer?

1 - age
2 - many ovulations
3 - early menarche
4 - multiple pregnancy
5 - late menopause

4 - multiple pregnancy

Nulliparity = a woman who has never given birth to a person

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Which 2 of the following are associated with reducing the risk of ovarian cancer?

1 - multiparity
2 - COC
3 - fertility treatment
4 - early menarche

1 - multiparity
2 - COC

COC reduces the number of ovulations and therefore ovarian cancer

Fertility treatment has a weak association with ovarian cancer

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Ovarian cancers can be epithelial and non-epithelial in origin. Which of these accounts for 90% of ovarian cancers?

epithelial cancers

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Which of the following is the definition of an epithelial ovarian cancer?

1 - arise from oocytes
2 - arise from the surface of the ovary
3 - arise from the surface of the fallopian tubes
4 - arise from the hormone secreting and connective cells of the ovaries

2 - arise from the surface of the ovary

most common subtype is serosa

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All of the following are classifications of epithelial ovarian cancers. Which of these accounts for 70-80% of these?

1 - endometriod carcinomas
2 - mucinous carcinomas
3 - clear cell carcinomas
4 - serous carcinomas
5 - undifferentiated

4 - serous carcinomas

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Which of the following is the definition of an germ cell ovarian cancer?

1 - arise from oocytes
2 - arise from the surface of the ovary
3 - arise from the surface of the fallopian tubes
4 - arise from the hormone secreting and connective cells of the ovaries

1 - arise from oocytes
- germ cell relates to reproductive cells

most common subtype is dysgerminoma

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Which of the following is the definition of an stromal-sex cell ovarian cancer?

1 - arise from oocytes
2 - arise from the surface of the ovary
3 - arise from the surface of the fallopian tubes
4 - arise from the hormone secreting and connective cells of the ovaries

4 - arise from the hormone secreting and connective cells of the ovaries

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Are ovarian tumours more common in the proximal (closer to uterus) or distal end of the fallopian tubes?

distal end

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All of the following are clinical signs of ovarian cancers, EXCEPT which one?

1 - unilateral abdominal distension and bloating
2 - unilateral abdominal and pelvic pain
3 - urinary symptoms (urgency)
4 - early satiety
5 - diarrhoea
6 - vaginal discharge
7 - abnormal vaginal bleeding

6 - vaginal discharge

Pain can be sharp or dull
Irregular menstrual cycle (abnormal vaginal bleed)

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In a patient with suspected ovarian cancer, which of the following would NOT be common?

1 - ascites
2 - pelvic/abdominal mass
3 - pleural effusion
4 - psoriasis
5 - lymphadenopathy

4 - psoriasis

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Malignant ovarian cancers can metastasise. Which of the following is typically NOT sites of secondary metastasis?

1 - pelvic peritoneum
2 - pelvic and peri-aortic lymph nodes
3 - abdominal peritoneum
4 - bones

4 - bones

Can metastasise, but the other 3 are far more likely

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Can ovarian cancer lead to ovarian torsion?

If it ruptures patient will have agonising pain
Medical emergency

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What cancer marker needs to be screened initially according to NICE guidelines if we suspect ovarian cancer?

1 - carbohydrate antigen 19-9 (CA19-9)
2 - cancer antigen-125 (CA-125)
3 - alpha-fetoprotein (AFP)
4 - carcinoembryonic antigen (CEA)

2 - cancer antigen-125 (CA-125)

Carbohydrate antigen 19-9 (CA19-9) = pancreatic

Alpha-fetoprotein (AFP) = liver, but can be raised in ovarian cancer as well

Carcinoembryonic antigen (CEA) = colon cancer

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Cancer antigen-125 (CA-125) should be screened if a patient is suspected of having ovarian cancer. What cut off would trigger the need to perform an abdominal ultrasound in a patient according to NICE guidelines?

1 - >3.5 IU/mL
2 - >35 IU/mL
3 - >350 IU/mL
4 - >3500 IU/mL

2 - >35 IU/mL

Cancer antigen-125 (CA-125) should be screened if a patient is suspected of having ovarian cancer. However, CA-125 has been showed be raised in all of the following, EXCEPT which one?

1 - endometriosis
2 - menstruation
3 - HPV infection
4 - benign ovarian cysts

3 - HPV infection

Although imaging is often not diagnostic in ovarian cancer, which imaging modality is 1st line?

1 - transvaginal ultrasound
2 - abdominal MRI
3 - abdominal CT

1 - transvaginal ultrasound

CT only if CA-125 is high and ultrasound suggest ovarian cancer

Bimanual examination can be effective at identifying a mass

Why is it difficult to identify the prevalence of ovarian cysts?

most women don’t have any symptoms so don’t know they have them
normally a random finding in an examination

In the follicular development of the menstrual cycle, which hormone is key for the development of follicles?

1 - LH
2 - FSH
3 - testosterone
4 - oestrogen

2 - FSH
- also drives the formation of the dominant follicle

Which hormone is key for driving ovulation?

1 - LH
2 - FSH
3 - testosterone
4 - oestrogen

1 - LH

There are functional and non-functional cysts. There are 3 types of functional cysts, what are they?

1 - follicular, corpus luteum, theca letein
2 - follicular, PCOS , theca letein
3 - chocolate, corpus luteum, theca letein
4 - follicular, corpus luteum, PCOS

1 - follicular, corpus luteum, theca letein

Follicular cysts can grow and become >2.5cm in diameter. These follicular cysts contain granulosa cells. What do granulosa cells secrete which is able to decrease the frequency of menstruation (normal vaginal bleeding)?

- estrogen - excess estrogen produced by follicular cells leads to decreased frequency of menstruation - decreased frequency of menstruation = increased risk of follicular cysts

If pregnancy doesn't occur, what is the general life span of the corpus luteum? 1 - 5 days 2 - 10 days 3 - 14 days 4 - 21 days

3 - 14 days

If an egg is fertilised the corpus luteum will continue to produce progesterone for how long? 1 - 4 weeks 2 - 8 weeks 3 - 12 weeks 4 - 14 weeks

4 - 14 weeks

In the management of ovarian cysts a woman needs to be confirmed as non pregnant, what 2 tests could be performed? 1 - ultrasound and serum hCG 2 - ultrasound and urine pregnancy test 3 - urine pregnancy test and hCG 4 - urine pregnancy test and ultrasound

3 - urine pregnancy test and blood hCG

51 year old lady is referred to the assessment unit by her primary care team. She has: - 2/52 history of breathlessness on exertion - several months of pelvic pain and increasing abdominal girth despite decreased appetite and poor oral intake - she looks unwell, her abdomen is tense and distended and you think she has ascites - SOB on exertion and bilateral pleural effusions - raised CA125 What imaging modality would be most useful to identify the diagnosis? 1 - abdominal ultrasound 2 - pelvic CT 3 - CT TAP 4 - MRI

3 - CT TAP TAP = thoracic, abdominal and pelvic Results confirm an ovarian mass, large volume ascites, numerous omental (fat above abdominal organs) metastases and bilateral pleural effusions

51 year old lady is referred to the assessment unit by her primary care team. She has: - 2/52 history of breathlessness on exertion - several months of pelvic pain and increasing abdominal girth despite decreased appetite and poor oral intake - she looks unwell, her abdomen is tense and distended and you think she has ascites - SOB on exertion and bilateral pleural effusions - raised CA125 What is the most likely diagnosis? 1 - liver cancer 2 - colon cancer 3 - ovarian cancer 4 - lung cancer

3 - ovarian cancer

51 year old lady is referred to the assessment unit by her primary care team. She has: - 2/52 history of breathlessness on exertion - several months of pelvic pain and increasing abdominal girth despite decreased appetite and poor oral intake - she looks unwell, her abdomen is tense and distended and you think she has ascites - SOB on exertion and bilateral pleural effusions - raised CA125 - ovarian mass, large volume ascites, numerous omental (fat above abdominal organs) metastases on CT How can we identify the primary tumour? 1 - PET-CT 2 - image guided core biopsy 3 - needle biopsy 4 - any of the above

2 - image guided core biopsy This will tell us the type of cancer In this case a high grade serous epithelial ovarian cancer is confirmed from the metastatic biopsy This is the most common form of ovarian cancer

This is the basic staging for FIGO

51 year old lady is referred to the assessment unit by her primary care team. She has: - 2/52 history of breathlessness on exertion - several months of pelvic pain and increasing abdominal girth despite decreased appetite and poor oral intake - she looks unwell, her abdomen is tense and distended and you think she has ascites - SOB on exertion and bilateral pleural effusions - raised CA125 - ovarian mass, large volume ascites, numerous omental (fat above abdominal organs) metastases on CT Is this women suitable for complete cytoreduction (removal of all visible cancer) of all macroscopic disease?

- no She has metastatic disease Typically the aim of ovarian cancer is surgical cytoreduction, BUT not possible here

The same as previous slide patient would receive 3 cycles of neoadjuvant platinum based chemotherapy, with the following results: - CA125 has fallen to the normal range - End of treatment CT TAP shows an excellent response with regression of several metastases and significant reduction of size of the others. She is now operable and proceeds to surgery. She has a total abdominal hysterectomy and bilateral salpingo-oophorectomy and all other visible disease is removed. Is this surgery palliative or radical?

- radical The aim is curative

Patients with ovarian cancer may have genetic mutations, such as the breast cancer susceptibility gene 1 and 2 (BRCA1/2). Which of the following should these patients be offered prior to and following treatment? 1 - genetic counselling 2 - breast cancer screening (annual MRI for 30-49 and mammogram a5 40 y/o) 3 - modify risk factors (smoking, obesity, exercise) 4 - preventative breast surgery (bilateral mastectomy and salpingo-oophorectomy) 5 - all of the above

5 - all of the above

If a patient has a mutation in the tumour suppressor genes BRCA1 and 2, this can lead to tumour development. Which of the following drugs can be used to inhibit tumours that are growing due to BRCA 1 and 2 mutations? 1 - Aromatase inhibitors 2 - Tamoxifen 3 - PARP inhibitors 4 - all of the above

3 - PARP inhibitors PARP = Poly (ADP-ribose) polymerase PARP is an enzyme involve din DNA and cellular repair If you inhibit PARP then tumour cells cannot continually repair themselves and die Typically only with in BRCA1 and 2 mutations

Which of the following is stage 1 according to the FIGO classification? 1 - tumour involves 1 or both ovaries/fallopian tubes with pelvic extension (below pelvic brim) or with primary peritoneal cancer 2 - tumour involves 1 or both ovaries or fallopian tubes, or primary peritoneal cancer, with histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes 3 - tumour confined to the ovaries or fallopian tubes 4 - Distant metastasis excluding peritoneal metastasis

3 - tumour confined to the ovaries or fallopian tubes

Which of the following is stage 2 according to the FIGO classification? 1 - tumour involves 1 or both ovaries/fallopian tubes with pelvic extension (below pelvic brim) or with primary peritoneal cancer 2 - tumour involves 1 or both ovaries or fallopian tubes, or primary peritoneal cancer, with histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes 3 - tumour confined to the ovaries or fallopian tubes 4 - Distant metastasis excluding peritoneal metastasis

1 - tumour involves 1 or both ovaries/fallopian tubes with pelvic extension (below pelvic brim) or with primary peritoneal cancer

Which of the following is stage 3 according to the FIGO classification? 1 - tumour involves 1 or both ovaries/fallopian tubes with pelvic extension (below pelvic brim) or with primary peritoneal cancer 2 - tumour involves 1 or both ovaries or fallopian tubes, or primary peritoneal cancer, with histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes 3 - tumour confined to the ovaries or fallopian tubes 4 - Distant metastasis excluding peritoneal metastasis

2 - tumour involves 1 or both ovaries or fallopian tubes, or primary peritoneal cancer, with histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes

Which of the following is stage 4 according to the FIGO classification? 1 - tumour involves 1 or both ovaries/fallopian tubes with pelvic extension (below pelvic brim) or with primary peritoneal cancer 2 - tumour involves 1 or both ovaries or fallopian tubes, or primary peritoneal cancer, with histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes 3 - tumour confined to the ovaries or fallopian tubes 4 - Distant metastasis excluding peritoneal metastasis

4 - Distant metastasis excluding peritoneal metastasis

In a patient with a confirmed diagnosis of ovarian cancer, what is the most appropriate treatment, given that the majority of cancers are diagnosed at stages III and IV? 1 - radiotherapy alone 2 - total abdominal hysterectomy with bilateral salpingo oophorectomy 3 - chemotherapy and radiotherapy 3 - total abdominal hysterectomy

2 - total abdominal hysterectomy with bilateral salpingo oophorectomy - also take lymph node and peritoneal biopsies - chemotherapy and radiotherapy may also be given afterwards

Although routine screening is NOT performed, which of the following groups of patients would require further screening? 1 - positive for BRCA1 and Lynch mutation 2 - family history of breast cancer alone 3 - colorectal cancer alone 4 - all of the above

1 - positive for BRCA1 and Lynch mutation - all of these patients are likely to recieve extra screening, but this is the most at risk group

If a patient develops neutropenic sepsis due to the cancer treatment, in addition to initiating the sepsis 6, what can be given in an attempt to increase the neutrophil count? 1 -dexamethasone 2 - granulocyte colony stimulating factors (GCSF) 3 - blood transfusion 4 - frozen WBCs

2 - granulocyte colony stimulating factors (GCSF)