Ovarian cancer Flashcards
Most common type of ovarian tumour?
Serous epithelial - 80%
What are the types of surface epithelial tumours and their origins?
Serous - fallopian tube
Mucinous - endocervical/intestinal
Endometrioid - atypical endometriosis
Clear cell - atypical endometriosis
Transitional - Brenner tumour
Epithelial-stromal adenosarcoma
SMECTE
Common primary cancer for metastatic ovarian cancer?
Colon, gastric, breast
Histological features of clear cell carcinoma?
Hob nail cells protruding into lumen
Risk factors ovarian cancer?
Increasing age, nulliparity, infertility, perineal talc use, obesity, HRT
Protective factors ovarian cancer?
Oral contraceptive pill, breastfeeding, sterilisation
FIGO stage 1 ovarian cancer is..
confined to ovaries/tubes,
Stage 1a ovarian cancer…
ONLY 1 ovary or tube affected
Stage 1c ovarian cancer…
leak of cancer cells into pelvis/surface of ovaries
1c1 - surgical spill
1c3 malignant cells in peritoeal washings
FIGO stage 2 ovarian cancer has spread to…
2a - womb
2b - bowel, bladder
FIGO stage 3 ovarian cancer has spread to…
retroperitoneal lymph nodes +/- metastasis beyond pelvis
3a - positive nodes or microscopic metastasis beyond pelvis
3b - macroscopic extrapelvic metastasis
FIGO stage 4 ovarian cancer is
distant metastasis
4a - lunch pleural effusion
4b - hepatic, splenic, extraabdominal lymph
Chemotherapy used in ovarian cancer?
Carboplatin with paclitaxel
6 cycles, 3 weekly intervals
What is adjuvant chemo?
Given after surgery in stage 2+ ovarian ca
Platinum-based chemo is 1st line + paclitaxel (taxane agent)
What is neoadjuvant chemo?
Chemo administered prior to surgery
Usually carboplatin + paclitaxel
3 cycles >interval debulking > further 3 cycles
When is neoadjuvant chemo used?
Used in advanced ovarian ca, heavy tumour burden or poor performance status
Features of a serous cystadenoma
Benign
Reproductive years
10% bilateral
Cystic, unilocular
Single layer cuboidal serous epithelium
Types of borderline tumours?
Serous 50% - e.g serous adenofibroma, serous cystadenofibroma
Mucinous - 46%
Endometriod, Brenner, Clear cell, Mixed
Features of serous adenofibroma?
Solid tumours, 1-15cm
20% bilateral
Simple glands lined by serous epithelium dispersed throughout a fibrous stroma
Features of serous cystadenofibroma?
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
Risk factors for bordeline ovarian tumours?
Younger aged women
Nulliparous
Features of BOTS in general?
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
5 year survival for serous BOTS?
95%
10 year survival rate for late stage BOTS?
30%
How are BOTS managed and why?
Surgery is mainstay
Chemotherapy poorly effective due to slow rate of growth of abnormal cells.
BOTs with the poorest prognosis have…?
Micropapillary serous
DNA aneuploidy
Invasive implants
Which type of BOT has a raised Ca19-9?
Mucinous
What happens after surgery for BOTs?
10 year follow up - every 3 months for 2 years, then every 6 months for 2 years, then annually
No routine adjuvant chemo
What is the most common primary malignant ovarian neoplasm?
Serous carcinoma
Features of serous carcinoma?
40-60 years
50% bilateral
Serosanguinous fluid, friable haemorrhagic cyst contents
Psammoma bodies
Irregular branching papillae
Can be glandural/papillary/solid
What is a psammoma body?
round dystrophic calcification
seen in ovarian ca, endometrial ca, pituitary prolactinoma
Features of mucinous cystadenoma?
Reproductive age
5% bilat
Cystic and multilocaular, contains thick mucinnous contents
Big 1-50cm
Fibroud cyst lined by single layer of simple columnar epithelium
Features of mucinous carcinoma?
40-60years
25% bilat
Cystic and solid, up to 50cm
Stromal invasion
Features of endometrioid ovarian tumours?
Chocolate coloured contents, assoc with endo
Haemosiderin laden macrophages, xanthogranulomatous reaction
Features of clear cell ovarian tumour?
Epithelial origin
60-70years old
40% bilat
Hobnail cells with clear cytoplasm
Chemo resistant (as slow progress) - recurrences can occur
What is a Brenner tumour?
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
Features of transitional cell ovarian tumour?
High grade papillary tumour
Resembles bladder invasive TCC
In disease recurrence, what does platinum sensitive refer to?
disease progress with an interval of >12 months after chemo completion
In disease recurrence, what does platinum resistance refer to?
disease progress with an interval of <6 months after chemo completion
In disease recurrence, what does platinum refractory refer to?
disease progress during chemo or within 4 weeks of completion
Example of a platinum chemotherapy?
Carboplatin
Cisplatin
(Often given with a TAXANE e.g. paclitaxel)
