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Medical Oncology SCE > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

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USMLE® Step 1 flashcards
1
Q

Which mutations are commonly seen in high grade serous carcinoma

A

TP53, SMARCA4, HRD (ie. BRCA)

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2
Q

Which mutations are commonly seen in mucinous carcinoma?

A

HER2, KRAS

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3
Q

Which mutations are commonly seen in Low grade serous?

A

BRAF, KRAS (TP53 wild type)

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4
Q

Which mutations are seen in clear cell ovarian cancer?

A

ARID1A, KRAS, PTEN and PIK3CA

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5
Q

Which patients with ovarian cancer should be offered germline BRCA testing?

A

All patients with non mucinous ovarian cancer

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6
Q

What percentage of HGSC have HRD?

A

50%

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7
Q

What percentage of HGSC have a germline BRCA mutation?

A

15%

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8
Q

Do BRCAm ovarian have a better or worse response to chemotherapy?

A

BRCAm predicts better response to platinum based chemo and improved survival

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9
Q

What should be included for complete surgical staging in ovarian cancer?

A

Hysterectomy, BLSO, peritoneal biopsies, omentectomy and lymph node sampling

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10
Q

When would you consider NACT?

A

If patients have a high risk peri-operative mortality or high risk of incomplete cytoreduction.

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11
Q

Which adjuvant chemotherapy regime is used and what is the response rate?

A

6 cycles of 3 weekly carboplatin AUC5 and paclitaxel 175mg/m2, 70% response rate

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12
Q

When are patients eligible for bevacizumab adjuvantly and when would it be started?

A

If presence of distant metastases or >1cm of residual disease. Bevacizumab to start alongside 2nd post op cycle of chemotherapy. Up to 18 doses.

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13
Q

Which treatments are licensed for maintenance treatment in BRCAm HGSOC after partial or complete response to chemotherapy?

A

Olaparib or niraparib

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14
Q

What maintenance strategy would you use for BRCAm HGSOC who are high risk

A

Niraparib or olaparib +- bevacizumab

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15
Q

Which maintenance treatment would be used in a patient with a homologous repair proficient HGSOC

A

Bevacizumab or Niraparib

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16
Q

Which maintenance treatment would be used in a patient with a homologous repair deficient HGSOC

A

Niraparib if low risk. If high risk niraparib, olaparib/bevacizumab

17
Q

How long can olaparib be used adjuvantly?

A

2 years but can be continued in residual disease that stays stable

18
Q

Define ‘platinum sensitive disease’

A

DFI of >12 months

19
Q

Define ‘partially platinum sensitive’

A

DFI of 6-12m

20
Q

Define ‘platinum resistant’

A

DFI <6 months

21
Q

Define ‘platinum refractory’

A

Progression during therapy or within 4 weeks of completion

22
Q

What would you define as biochemical progression

A

If Ca 125 has doubled

23
Q

When would you consider rechallenge with platinum chemotherapy

A

If DFI >4 months and favourable response to last platinum based chemotherapy

24
Q

What would be the first line treatment in platinum resistant disease?

A

Weekly paclitaxel

25
Q

What would be your first line treatment on relapse of platinum sensitive disease?

A

Carboplatin and pegylated liposomal doxorubicin (Caelyx) or alternative platinum double followed by maintenance rucaparib (if not had previous PARPi).

26
Q

When can olaparib be used in the relapsed setting?

A

Used as maintenance in platinum sensitive BRCAm patients following second platinum based chemotherapy regime if not had PARPi previously.

27
Q

Lifetime risk of ovarian cancer in BRCA1m?

A

45%

28
Q

Lifetime risk of ovarian cancer with BRCA2m?

A

17%

29
Q

Which PARPi is linked to photosensitivity?

A

Rucaparib

30
Q

Which PARPi is associated with HTN?

A

Niraparib

31
Q

What tumour markers is most useful to diagnose a granulosa cell tumour?

A

Inhibin

32
Q

What percentage of ovarian cancers are attributable to BRCA mutations?

A

15%

33
Q

What feature of a borderline ovarian cancer would upgrade it to a low grade epithelial carcinoma?

A

Presence of invasive implants (peritoneal)

34
Q

What feature of a borderline ovarian cancer would upgrade it to a low grade epithelial carcinoma?

A

Presence of invasive implants (peritoneal)

35
Q

Granulosa cell tumours are associated with which other malignancy and by which mechanism?

A

Endometrial as they increase oestrogen production resulting in endometrial proliferation.

36
Q

What is the most important independent prognostic factor or survival for a patient with ovarian cancer?

A

Resection of all macroscopic disease

Medical Oncology SCE (27 decks)

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