Ovarian cancer Flashcards
What is stage 1 ovarian cancer?
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.
What is stage 2 ovarian cancer?
spread to pelvis below pelvic brim or primary peritoneal cancer
stage 2A: spread/implants to uterus
Stage 2B: spread to over pelvic intraperitoneal tissues.
What is stage 3 ovarian cancer?
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
What is stage 4 ovarian cancer?
Distant metastasis (Excludes peritoneal mets)
4A: pleural effusion with + cytology
4B: parenchymal disease (eg liver, spleen) +/- extra abdominal disease
What are features that increase changes of malignancy?
Old age
bilateral mass
solid
complex
excrescences (papillary projections)
septations
bloody fluid
size >10cm
duration (persistent mass, DOES NOT reduce w/ menses or OCP)
What is the differential diagnosis for a solid tumor?
Fibroid
Thecoma
Fibroma
Brenner
Granulosa cell tumor
Dysgermimoma
What is the differential diagnosis for a cystic tumor?
Functional cyst
Serous and mutinous tumor
Mature cystic teratoma
Endometrioma
Rates of bilaterally of ovarian tumors
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%
What is Ca-125?
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!
What is AFP?
endodermal sinus tumors (yolk sac) and embryonal tumors
What is HCG?
Choriocarcinoma, embryonal carcinoma, dysgermimoma
What is estrogen?
Granulosa cell tumor
What are androgens?
theca, fibroma, sertoli-leydig cell
What is inhibin?
Granulosa cell tumor
What is LDH
dysgermimoma
What is the criteria for a borderline tumor?
Epithelial stratification
Papillations
Nuclear atypia
NO STROMAL INVASION
What is a dysgermimoma?
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.
What is a granulosa cell tumor?
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.
Random
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.
What are coffee bean nuclei associated with?
Granulosa cell tumor/Brenner tumor
What are Schiller Duval bodies associated with?
Endodermal sinus tumor (yolk sac)
What are call-exner bodies associated with?
Granulosa cell tumor (call-girl!)
What are psamomma bodies associated with?
low-malignant potential tumors
serous tumors (body builders are serious!)
clear cell
What does “cellular proliferation w/ nuclear atypia” suggest?
low malignant potential tumor
What are sex cord stromal ovarian tumors?
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)
What are germ cell tumors?
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)
How do you workup pt with constipation, bloating, poor appetite. pelvic uS w/ complex mass and elevated CA-125?
- workup for mets: CT/MRI, CXR, CMP
- refer to gyn onc
- if concern for cancer, on imaging, need laparoscopy for adequate staging.
What is the lifetime risk of ovarian cancer?
1.8%
- breast cancer is 12%
What are benign adnexal masses in pregnancy?
- Luteal cyst of pregnancy
- Hemorrhagic cyst
- Paratubal cyst
- Mature cystic teratoma
- Benign neoplasm: serous cyst adenoma.
