Ovarian cancer Flashcards
How often are they benign?
80%
How common? Deaths?
2 (after endometrial cancer?)
But #1 KILLER (wrt gynecologic cancer). Accounts for 50% of deaths from female genital tract cancer. This is cuz there aren’t screening tools.
5 year survival
25-45%
How often are they epithelial tumors?
90%
Which is caused from GI mets?
Krukenberg
Spread?
Direct exfoliation
Lymphatic
Hematogneous (brain/lung)
Symptoms of advanced disease?
Ascites, bowel encaseemnt causing intermittent bowel obstruction aka “carcinomatous ileus”
Cause?
Unclear but believed to be after chronic uninterrupted ovulation (this disrupts the epithelium and activates cell repair mechs)
Genetic risk?
BRCA1 85% breast cancer risk, 30-50% ovarian cancer risk
HNPCC
Cancer tends to occur 10 years earlier than these people (so like 50s or even 40s)
Average age of diagnosis?
61 (same as endometrial) with 2/3 being over age 55.
Risk factors
Familial ovarian cancer syndrome hx > familial hx of it Breast cancer Uninterrupted ovulation Increasing age Talcum powder Obesity BMI >30
Protective factors
OCPs, breastfeeding, multiparity, chronic anovulation, infertility, early menarche, nulliparity, late menopause
TUBAL LIGATION AND HYSTERECTOMY
Physical exam
Possibly solid, fixed, irregular pelvic mass
Mets to umbilicus aka Sister Mary Joseph nodule
Ascites
Diagnosis
Pelvic ultrasound
Barium enema and IVP help r/o GI and genitourinary causes of sx.
Need to look for mets as soon as you make diagnosis
MONITORING WITH CA-125, AFP, LDH, hCG
Remember that CA-125 is actually very nonspecific and can be seen in lots of cancers or benign conditions, like pancreatitis, cirrhosis, endometriosis, fibroids, normal/ectopic pregnancy, PID, peritonitis
Staging
SURGICAL
TAHBSO, omentectomy, peritoneal washings, pap smear of diaphragm, pelvic and paraaortic LN sampling
Treatment for malignant epithelial tumors?
Surgery + chemo
What chemo agents for epithelial?
Carboplatin and paclitaxel
Patients with optimal debunking given intraperitoneal cisplatin and paclitaxel chemo along with IV chemo
For evaluating success of treatment of epithelial?
CA-125 and CAT scan imaging
How often do epithelial recur?
Frequently. Give chemo.
5 year survival
20% for epithelial (80-95% for stage 1, 40-70% for stage II, 30% for stage III…)
What are the epithelial cancers?
#1 is serous cystadenocarcinoma Mucinous Endometrioid Clear cell Brenner Undifferentiated
CAUCASIAN
Describe serous tumors
large, cystic, bilateral 65% of the time
Germ cell tumors? Age group?
0-25 yo. (younger more likely to be malignant)
Also more common in blacks and Asians.
Benign cystic mature teratoma aka dermoid cyst is MC. 95% are benign
Malignant:
- Dysgerminomas 50%
- Immature teratomas 20%
- Endodermal sinus (yolk sac) 20%
- Uncommon: Embroynal carcinoma, nongestational choriocarcinoma (composed of placenta tissue), mixed germ cell
In contrast to epithelial tumors, germ cell tumors:
Grow rapidly, are limited to one ovary, and are stage I at diagnosis, considered quite curable
Marker for dysgerminoma
LDH
Marker for endodermal sinus
AFP
Marker for embroynal
AFP and hCG
Marker for choriocarcinoma
HCG
Clinical manifestations of germ cell tumors
Most women have abdominal pain.
Grow rapidly so tend to hemorrhage and necrosis, so acute pelvic pain
Treatment for germ cell tumors
Unilateral salpingo-oophorectomy (if fertility is desired)
Otherwise, TAHBSO with surgical staging.
Everything but stage Ia dysgerminomas and immature teratomas req multi agent chemo: BEP- bleomycin, etoposide, cisplatin.
Very curable
Sex cord stromal tumors
Low grade and can occur at any age. Unilateral, rarely recur. Ages 40-70. Since some are functional and produce estrogen, may have concomitant endometrial hyperplasia (25-50%) or carcinoma (5%).
Granulosa-theca (70%)
Sertoli-Leydig
Ovarian fibroma
Granulosa-theca characteristics
Resemble fetal ovaries Produce lots of estrogen Coffee-bean nuclei "Call-exner bodies" Produce estradiol and inhibinA/B (get an endometrial sampling!)
Sertoli-Leydig characteristics
Resemble fetal testes
Produce testosterone, androgens (virilization)
Fibroma characteristics
Mature fibroblasts, NOT FUNCTIONING (unlike the others)
Ascities, right hydrothorax, mass = Meigs syndrome
Treatment of sex cord stromal tumors?
Unilateral salpingoophorectomy.
Chemo and radiation have no regular role!
Fallopian tube cancer
Can occur at any age.
Progression similar to ovarian cancer w/ peritoneal spread and ascites.
Most are adenocarcinomas
10% bilateral (often the result of mets)
Very very rare
Epidemiology of fallopian tube cancer
Caucasian, 55-60 yo.
BRCA1 and 2, nulliparity, infertility
Clinical manifestations of fallopian tube cancer
Asymptomatic usually
Latzko’s triad: profuse watery discharge, pelvic pain, pelvic mass
Hydrops tubae profluens (intermittent hydrosalpinx)
Diagnosis of fallopian tube cancer, staging, treatment
Often incidental finding during surgery. CA-125 may be elevated.
Surgical staging.
Same treatment as ovarian
Chemo w/ carboplatin and paclitaxel.
Prognosis slightly better than epithelial ovarian cancer.
What is a dermoid cyst?
Benign cystic teratoma
How often are dermoid cysts bilateral?
10%
