Ovarian cancer

Question 1

What is the most common germ cell tumor?

Answer 1

1) Dysgerminoma (35-45%)
2) Immature teratoma (20-30%)
3) Endodermal sinus/yolk sac tumor (14.5%)

Question 2

What are the important points on endodermal sinus tumors?

Answer 2

-75-80% are stage 1 at diagnosis.
-10-15% are bilateral.
-30% have LN involvement.
-can biopsy an abnormal ovary because extremely chemosensitive tumor.

Question 3

What is the most frequent malignancy occurring in a mature teratoma?

Answer 3

SCC
* note no specific tumor markers for mature teratoma.

Question 4

What are the important points of Sertoli Leydig tumors?

Answer 4

-LN assessment not required at surgery bcs rarely metstasize to LN.

-Crystalloids of Renke are histological feature.

Question 5

What are the important cytotoxic side effects of BEP?

Answer 5

1) AML can occur secondary to etopiside.
2) Bleomycin causes pulmonary fibrosis (doses > 400 U can be fatal).

Question 6

What are the chemotherapy rules for immature teratomas?

Answer 6

-Stage A1, G1 can be be observed.
- > Stage 1A, G1 requires 3-4 cycles of BEP.

Question 7

What is the lifetime risk of ovarian cancer with BRCA and Lynch mutations?

Answer 7

1) BRCA1 = 40%
2) BRCA2= 16-18%.
3) Lynch - 12%.

Question 8

What causes the hypersensitivity reaction with Taxol?

Answer 8

Cremaphor (castor oil) - treated with steroids.

Question 9

What is side effect of the chemotherapy agent Etoposide?

Answer 9

AML

Question 10

What is the side effect of the chemotherapy agent Bleomycin?

Answer 10

1) Pulmonary fibrosis
2) If cumulative dose > 400 units, this can be fatal.

Question 11

Cystalloids of Renke are seen in which sex cord stromal tumor?

Answer 11

Leydig

Question 12

Where do Krukenberg tumors metastasize from?

Answer 12

Stomach > Colon > Appendix> Breast > Biliary tract

Question 13

What are components of the RMI?

Answer 13

Mnemonic:
A: ascites
B: Bilateral
C: Cyst (multiloculated)
D: SoliD
E: Extrapelvic disease/metastasis

Menopausal status, Bilateral, Multiloculated, Solid areas, Metastasis, and Ascites.

• Note size is not a criteria.
• Note RMI II devalues points given to CA-125 by scoring 4 for two or more US features and 4 if menopausal.

Question 14

What are the IOTA benign ovarian mass rules?

Answer 14

-Unilocular cyst
-Smooth multilocular tumor < 10cm.
-Solid components < 7mm in diameter.
-Presence of acoustic shadows.
-No detectable doppler signal.