Ovarian Cancer Flashcards
adnexa
uterine appendages; Fallopian tubes/ovaries/supporting tissue
5-year survival of ‘distant’ stage ovarian cancer
28%
most prevalent stage of ovarian cancer
‘distant’ stage (60%); 5 year survival = 28%
ovarian cancer is staged clinically or surgically?
surgically
ovarian cancer that has spread to upper abdomen or regional LNs is stage:
stage III (most common - 60%)
ovarian cancer that is limited to pelvis is stage:
II
ovarian cancer found in liver or lungs is stage:
IV
median age of presentation of ovarian cancer
65 y.o.
most common type of ovarian cancer:
- germ cell
- epithelial ovarian cancer (EOC) or
- sex-cord stromal
EOC (80%); germ cell (15%); sex-cord stromal (5%)
serous, mucinous, endometroid, clear cell, transitional cell, undifferentiated are all types of ____ ovarian cancer and are derived from:
epithelial ovarian cancer (EOC); ovarian surface mesothelial cells
tend to occur in 6th decade of life
EOC
80% of malignant ovarian tumors are of what type?
epithelial ovarian cancer (EOC)
tend to occur in 2nd and 3rd decade of life
germ cell tumors
type of ovarian cancer with better prognosis
germ cell tumors
dysgerminoma, endometrial sinus tumor, teratomas, embryonal carcinoma, choriocarcinoma, mixed are all types of ____ ovarian cancer
germ cell tumors
type of ovarian cancer that often produces biological markers
germ cell tumors
type of germ cell tumor that produces LDH
dysgerminoma
tumors of younger women
sex cord stromal tumors and germ cell tumors
granulosa cell tumor
most common tumor of sex cord origin (1-2% of all ovarian neoplasms)
associated with hyperestrogenism; may cause precocious puberty (girls), adenomatous hyperplasia and vaginal bleeding in postmenopausal women
granulosa cell tumor (sex cord-stromal origin)
Risk factors for ovarian cancers
family history, age (older), endometriosis, nulliparity, early menarche/late menopause, late childbirth, environmental factors
risk reduction for ovarian cancer
oral contraceptive pills, multiparity, oophorectomy, tubal ligation/salpingectomy (from FT?), breastfeeding
non-specific and vague symptoms of ovarian cancer include:
-increase in abdominal girth, bloating, fatigue, abdominal pain, back pain, intercourse pain, early satiety, indigestion, constipation, unexplained weight loss, urinary frequency or incontinence
benign gynecologic differential for ovarian cancer symptoms:
functional cyst, leiomyomata, endometrioma, ectopic, teratoma, cystadenoma, TOA (tubo-ovarian abscess)
malignant gynecologic differential for ovarian cancer symptoms:
EOC, germ cell, sex-cord stromal
non-gynecologic differential for ovarian cancer symptoms:
- benign: diverticular or appendiceal abscess, nerve sheat tumor, pelvic kidney;
- malignant: colon, breast, gastric cancer
account for 10% epithelial ovarian cancers (EOC)
hereditary ovarian cancer
HNPCC associated with ovarian cancer
Lynch II
HBOC genes
BRCA1, BRCA2
40% ovarian cancer risk if this gene is mutated
BRCA1 chromosome 17; (10-20% if BRCA 2, chromosome 13)
10-15% ovarian cancer risk if this gene is mutated
HNPCC (lynch 2) – autosomoal dominant
Screening for ovarian cancer can include: A. physical exam B. pap smear C. TVUS D. biomarkers: CA125, ROMA, He4, OVA-1 E. All of above
all EXCEPT pap smear
Sister Mary Joseph’s Nodule indicates
stage IV ovarian cancer; specific nodule found at umbilicus
mobile, cystic, unilateral, smooth lymph node indicates ____ process
benign
fixed, solid or firm, bilateral, nodular indicates ___ process
malignant
TVUS findings of no blood flow to unilateral mass with septations
benign
TVUS findings of solid or cystic and solid, strong blood flow, multiple septations > 3 mm in size, bilateral and ascites suggests ___ process
malignant
TVUS findings of 9 cm simple cyst with calcifications suggests ____ process
benign
T or F: CA125 value of 100 u/mL in premenopausal patient indicates no tumors
could be true or false: may show normal value in 50-70% of stage I tumors and in 20-25% of advanced tumors. Abnormal values are thought to be >200 u/mL premenopausal and > 35 postmenopausal
T or F: simultaneous screening with CA125 and TVUS compared with usual care reduces ovarian cancer mortality
FALSE: did not reduce ovarian cancer mortality
characteristics of ultrasound findings of benign cyst
unilocular, thin-walled
ACOG (American Congress of OB/GYN) referral guidelines for pelvic mass in postmenopausal include:
postmenopausal women with suspicious pelvic mass that contains at least one:
-CA125 >35; -fixed or nodular pelvic mass; -FHx of ovarian or breast cancer; -distant mets; -ascites
ACOG referral guidelines for pelvic mass in premenopausal include:
-CA125>200; -ascites; -evidence of mets; -FHx of breast or ovarian cancer
T or F: 30 y.o. female with suspicious pelvic mass and CA125 of 40 should be referred
False: if was postmenopausal, then yes. (premenopausal needs CA125 >200)
T or F: 1 example of therapy plan for ovarian cancer would be giving platinum agent and taxane only.
False: usually combo of surgery and chemotherapy (platinum agent and taxane)
treatment for ovarian cancer:
combo of surgery ( staging, debulking, interval debulking) & chemo (adjuvant, neoadjuvant, taxane adn platinum agent)
CA125 tumor marker has many false negatives or false positives?
false positives
