Ovarian cancer Flashcards

1
Q

What is stage 1 ovarian cancer?

A

confined to the ovary or fallopian tubes

Stage 1A: limited to 1 ovary or tube, capsule intact, negative cytology

Stage 1B: both ovaries/tubes involved. capsule intact, tubal surface free.

Stage 1C1: +surgical spill
Stage 1C2: +capsule ruptured or tumor on ovarian/fallopian tube surface
Stage 1C3: positive washings.

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2
Q

What is stage 2 ovarian cancer?

A

spread to pelvis below pelvic brim or primary peritoneal cancer

stage 2A: spread/implants to uterus
Stage 2B: spread to over pelvic intraperitoneal tissues.

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3
Q

What is stage 3 ovarian cancer?

A

positive microscopically peritoneal metastasis outside pelvis or positive retroperitoneal nodes (pelvic or para-aortic).

3A: +retroperitoneal nodes
3A1: + nodes only
3A2: microscopic spray outside pelvis (above pelvic brim)

3B: macroscopic peritoneal spread beyond pelvis <2cm
3C: macroscopic peritoneal spread >2cm, capsule of liver/spleen

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4
Q

What is stage 4 ovarian cancer?

A

Distant metastasis (Excludes peritoneal mets)

4A: pleural effusion with + cytology
4B: parenchymal disease (eg liver, spleen) +/- extra abdominal disease

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5
Q

What are features that increase changes of malignancy?

A

Old age
bilateral mass
solid
complex
excrescences (papillary projections)
septations
bloody fluid
size >10cm
duration (persistent mass, DOES NOT reduce w/ menses or OCP)

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6
Q

What is the differential diagnosis for a solid tumor?

A

Fibroid
Thecoma
Fibroma
Brenner
Granulosa cell tumor
Dysgermimoma

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7
Q

What is the differential diagnosis for a cystic tumor?

A

Functional cyst
Serous and mutinous tumor
Mature cystic teratoma
Endometrioma

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8
Q

Rates of bilaterally of ovarian tumors

A

germ cell tumor (5-10%), exception is gonadoblastoma (40%)
- Fibroma 10%
- Serous carcinoma 66%
Mutinous carcinoma 20%
- Krukenberg 100% (mets from GI tract)
-Epithelial ovarian cancers: 20-25%, most are mets from one ovary (primary). Serous more likely to be bilateral than mucinous

  • Mucinous adenoma: 0%
  • Mucinous adenocarcinoma 10%
  • Serous adenoma 10%
  • Serous adenocarcinoma 66%
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9
Q

What is Ca-125?

A

tumor marker for serous epithelial tumors

Causes of false positives:
- appendicitis, cholecystitis, PID, fibroids, endometriosis, diverticulosis (anything ends in “itis” or “osis”

Causes of false negatives: CEA - mucinous epithelial tumors, 50% of stage 1 epithelial ovarian malignancies have normal Ca-125!

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10
Q

What is AFP?

A

endodermal sinus tumors (yolk sac) and embryonal tumors

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11
Q

What is HCG?

A

Choriocarcinoma, embryonal carcinoma, dysgermimoma

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12
Q

What is estrogen?

A

Granulosa cell tumor

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13
Q

What are androgens?

A

theca, fibroma, sertoli-leydig cell

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14
Q

What is inhibin?

A

Granulosa cell tumor

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15
Q

What is LDH

A

dysgermimoma

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16
Q

What is the criteria for a borderline tumor?

A

Epithelial stratification
Papillations
Nuclear atypia
NO STROMAL INVASION

17
Q

What is a dysgermimoma?

A

Most common type of malignant germ cell tumor.
- “fried eggs” on histo path: lymphocyte infiltrated storm w/ large vesicular cells

Chemosensitive - BEP regimen (bleomycin/etoposide/cisplatin).

2/3 diagnosed at Stage 1A

tx=USO and limited staging to spare fertility since most of patient are young/desirous of fertility. follow w/ serial tumor markers (LDH and hCG).

10-15% can be bilateral.

18
Q

What is a granulosa cell tumor?

A

Histology: call-exner bodies. Coffee bean nuclei (also seen in Brenner tumor).
- secretes estrogen and inhibin
- low malignant potential, arises from sex cord stromal cells.
- surgery alone=tx, most are stage 1A.

19
Q

Random

A

ovarian cancers associated with dysgenic gonads in presence of Y chromosome: dysgermimoma (germ cell) & gonadoblastoma (sex cord stromal)

Any HUGE ovarian tumor likely to be a benign mucinous cyst adenoma.

  • cancer=breach of basement membrane.
20
Q

What are coffee bean nuclei associated with?

A

Granulosa cell tumor/Brenner tumor

21
Q

What are Schiller Duval bodies associated with?

A

Endodermal sinus tumor (yolk sac)

22
Q

What are call-exner bodies associated with?

A

Granulosa cell tumor (call-girl!)

23
Q

What are psamomma bodies associated with?

A

low-malignant potential tumors
serous tumors (body builders are serious!)
clear cell

24
Q

What does “cellular proliferation w/ nuclear atypia” suggest?

A

low malignant potential tumor

25
Q

What are sex cord stromal ovarian tumors?

A

3-5% of ovarian tumors
- Granulosa cell (call Exner, coffee bean nuclei)
- Fibroma (thecoma elements, w/ Meig syndrome)
- Thecoma (produce estrogen)
- Sertoli-Leydig (testicular gonad, crystal of Reinke, testosterone production)
- Lipid cells (testosterone)
- Gonadoblastoma (both ovarian + testicular components, patients who have dysgenetic gonads like Turner’s, MALIGNANT)

26
Q

What are germ cell tumors?

A

1/3 of all ovarian neoplasms. most common gyn malignancy in pre-adolescents.
most are unilateral, do fertility sparing surgery - USO.
- Dermoid (mature cystic teratoma)=most common subtype.

  • Malignant:
  • dysgermimoma
  • yolk sac tumor
  • immature teratoma
    Others: Choriocarcinoma, endodermal sinus, gonadoblastoma (malignant only if associated dysgermimoma elements)
27
Q

How do you workup pt with constipation, bloating, poor appetite. pelvic uS w/ complex mass and elevated CA-125?

A
  • workup for mets: CT/MRI, CXR, CMP
  • refer to gyn onc
  • if concern for cancer, on imaging, need laparoscopy for adequate staging.
28
Q

What is the lifetime risk of ovarian cancer?

A

1.8%

  • breast cancer is 12%
29
Q

What are benign adnexal masses in pregnancy?

A
  • Luteal cyst of pregnancy
  • Hemorrhagic cyst
  • Paratubal cyst
  • Mature cystic teratoma
  • Benign neoplasm: serous cyst adenoma.