Ovarian cancer

Question 1

Most common type of ovarian tumour?

Answer 1

Serous epithelial - 80%

Question 2

What are the types of surface epithelial tumours and their origins?

Answer 2

Serous - fallopian tube
Mucinous - endocervical/intestinal
Endometrioid - atypical endometriosis
Clear cell - atypical endometriosis
Transitional - Brenner tumour
Epithelial-stromal adenosarcoma
SMECTE

Question 3

Common primary cancer for metastatic ovarian cancer?

Answer 3

Colon, gastric, breast

Question 4

Histological features of clear cell carcinoma?

Answer 4

Hob nail cells protruding into lumen

Question 5

Risk factors ovarian cancer?

Answer 5

Increasing age, nulliparity, infertility, perineal talc use, obesity, HRT

Question 6

Protective factors ovarian cancer?

Answer 6

Oral contraceptive pill, breastfeeding, sterilisation

Question 7

FIGO stage 1 ovarian cancer is..

Answer 7

confined to ovaries/tubes,

Question 8

Stage 1a ovarian cancer…

Answer 8

ONLY 1 ovary or tube affected

Question 9

Stage 1c ovarian cancer…

Answer 9

leak of cancer cells into pelvis/surface of ovaries

1c1 - surgical spill
1c3 malignant cells in peritoeal washings

Question 10

FIGO stage 2 ovarian cancer has spread to…

Answer 10

2a - womb
2b - bowel, bladder

Question 11

FIGO stage 3 ovarian cancer has spread to…

Answer 11

retroperitoneal lymph nodes +/- metastasis beyond pelvis
3a - positive nodes or microscopic metastasis beyond pelvis
3b - macroscopic extrapelvic metastasis

Question 12

FIGO stage 4 ovarian cancer is

Answer 12

distant metastasis
4a - lunch pleural effusion
4b - hepatic, splenic, extraabdominal lymph

Question 13

Chemotherapy used in ovarian cancer?

Answer 13

Carboplatin with paclitaxel
6 cycles, 3 weekly intervals

Question 14

What is adjuvant chemo?

Answer 14

Given after surgery in stage 2+ ovarian ca
Platinum-based chemo is 1st line + paclitaxel (taxane agent)

Question 15

What is neoadjuvant chemo?

Answer 15

Chemo administered prior to surgery

Usually carboplatin + paclitaxel
3 cycles >interval debulking > further 3 cycles

Question 16

When is neoadjuvant chemo used?

Answer 16

Used in advanced ovarian ca, heavy tumour burden or poor performance status

Question 17

Features of a serous cystadenoma

Answer 17

Benign
Reproductive years
10% bilateral
Cystic, unilocular
Single layer cuboidal serous epithelium

Question 18

Types of borderline tumours?

Answer 18

Serous 50% - e.g serous adenofibroma, serous cystadenofibroma
Mucinous - 46%
Endometriod, Brenner, Clear cell, Mixed

Question 19

Features of serous adenofibroma?

Answer 19

Solid tumours, 1-15cm
20% bilateral
Simple glands lined by serous epithelium dispersed throughout a fibrous stroma

Question 20

Features of serous cystadenofibroma?

Answer 20

1-20cm
clusters of small firm whitish nodules
nodules composed of cellular fibrous or acelllular hyalinised tissue lined by a single layer of serous epithelium

Question 21

Risk factors for bordeline ovarian tumours?

Answer 21

Younger aged women
Nulliparous

Question 22

Features of BOTS in general?

Answer 22

80% are limited to the ovary
30% have implants at diagnosis. 30% of these implants show stromal invasion which have worst outcome
Rule of 1/3rd

Question 23

5 year survival for serous BOTS?

Answer 23

95%

Question 24

10 year survival rate for late stage BOTS?

Answer 24

30%

Question 25

How are BOTS managed and why?

Answer 25

Surgery is mainstay Chemotherapy poorly effective due to slow rate of growth of abnormal cells.

Question 26

BOTs with the poorest prognosis have...?

Answer 26

Micropapillary serous DNA aneuploidy Invasive implants

Question 27

Which type of BOT has a raised Ca19-9?

Answer 27

Mucinous

Question 28

What happens after surgery for BOTs?

Answer 28

10 year follow up - every 3 months for 2 years, then every 6 months for 2 years, then annually No routine adjuvant chemo

Question 29

What is the most common primary malignant ovarian neoplasm?

Answer 29

Serous carcinoma

Question 30

Features of serous carcinoma?

Answer 30

40-60 years 50% bilateral Serosanguinous fluid, friable haemorrhagic cyst contents Psammoma bodies Irregular branching papillae Can be glandural/papillary/solid

Question 31

What is a psammoma body?

Answer 31

round dystrophic calcification seen in ovarian ca, endometrial ca, pituitary prolactinoma

Question 32

Features of mucinous cystadenoma?

Answer 32

Reproductive age 5% bilat Cystic and multilocaular, contains thick mucinnous contents Big 1-50cm Fibroud cyst lined by single layer of simple columnar epithelium

Question 33

Features of mucinous carcinoma?

Answer 33

40-60years 25% bilat Cystic and solid, up to 50cm Stromal invasion

Question 34

Features of endometrioid ovarian tumours?

Answer 34

Chocolate coloured contents, assoc with endo Haemosiderin laden macrophages, xanthogranulomatous reaction

Question 35

Features of clear cell ovarian tumour?

Answer 35

Epithelial origin 60-70years old 40% bilat Hobnail cells with clear cytoplasm Chemo resistant (as slow progress) - recurrences can occur

Question 36

What is a Brenner tumour?

Answer 36

Post-menopausal Solid and firm like a fibroid Urothelial like tumour Coffee bean nuclei, polygonal in shape Rarely malignant in 1% of cases and these are usually associated with a benign Brenner

Question 37

Features of transitional cell ovarian tumour?

Answer 37

High grade papillary tumour Resembles bladder invasive TCC

Question 38

In disease recurrence, what does platinum sensitive refer to?

Answer 38

disease progress with an interval of >12 months after chemo completion

Question 39

In disease recurrence, what does platinum resistance refer to?

Answer 39

disease progress with an interval of <6 months after chemo completion

Question 40

In disease recurrence, what does platinum refractory refer to?

Answer 40

disease progress during chemo or within 4 weeks of completion

Question 41

Example of a platinum chemotherapy?

Answer 41

Carboplatin Cisplatin (Often given with a TAXANE e.g. paclitaxel)