Ovarian Cancer

Question 1

What are the top two most common gyn cancers in the developed world?

Answer 1

1. Uterine

2. Ovarian

Question 2

What is the most lethal gyn cancer?

Answer 2

Ovarian cancer

Question 3

True or false: most of the ovarian cancers are discovered at a late stage

Answer 3

True

Question 4

What is the median age at diagnosis for ovarian cancer?

Answer 4

63 years

Question 5

What is the most important risk factor for the development of ovarian cancer?

Answer 5

Age

Question 6

Do BRCA1/2 increase the incidence of ovarian cancer

Answer 6

Yes

Question 7

Do oral contraceptives decrease the rate of ovarian cancer?

Answer 7

Yes

Question 8

What is the role of vaginal US in the prevention of ovarian cancer?

Answer 8

Not proven to be effective as a screening technique

Question 9

What is the role of Ca 125 in the detection of ovarian cancer? Why?

Answer 9

Not proven to be effective–none specific

Question 10

Why should you delay further workup for an ovarian mass if the woman is in the luteal phase of her menstrual cycle?

Answer 10

May be a corpus luteum cyst

Question 11

What are the s/sx of ovarian cancer?

Answer 11

• Bloating
• Increased abdominal girth
• Pelvic pain

Question 12

What are the PE findings of ovarian cancer?

Answer 12

• Ascites

- Adnexal lesions

Question 13

What is the most common adnexal mass in young women?

Answer 13

Benign cysts

Question 14

What is the most common adnexal mass in postmenopausal women?

Answer 14

More likely to be malignant than premenopausal women

Question 15

What should be r/o before suspecting ovarian cancer in premenopausal women? (4)

Answer 15

• Ectopic Pregnancy
• Cysts
• ruptured ovarian abscess
• Ovarian torsion

Question 16

What should be done in the workup of a postmenopausal woman for an adnexal mass?

Answer 16

• Breast exam, DRE, mammography
• CA-125
• TVUS

Question 17

What is the positive predictive value for adnexal US Imaging?

Answer 17

Low

Question 18

What are excrescences?

Answer 18

Irregularities on the surface

Question 19

Are unilocular ovarian masses more likely to be benign or malignant?

Answer 19

Benign

Question 20

What is the endocrine function of granulosa cell tumors? What is the classic histological finding of these?

Answer 20

Excessive estrogen production

Call-exner bodies

Question 21

How often should women who are found to have an ovarian tumor be seen? How often should imaging be obtained? What labs?

Answer 21

q 6 months indefinitely

3-5 years get a CT

Inhibin A and B

Question 22

What are the three tumor marker for malignant germ cell tumors?

Answer 22

b-hCG, LDH, AFP

Question 23

What is the tumor marker for embryonal carcinoma?

Answer 23

AFP

bhCG

Question 24

What is the tumor marker for endodermal sinus tumor?

Answer 24

AFP

Question 25

What is the tumor marker for granulosa cell tumors?

Answer 25

Inhibin

Question 26

What is cytoreductive surgery? When is this the optimal therapy?

Answer 26

Debulking--less than 1 cm in size

Question 27

What is the treatment for epithelial ovarian cancer?

Answer 27

Removal of uterus, tubes, ovaries, omentum, pelvic and paraaortic nodes

Question 28

What is the MOA of carboplatin?

Answer 28

Binds and crosslinks DNA to prevent DNA synthesis

Question 29

What is the MOA of paclitaxel?

Answer 29

binds to stable microtubules, and inhibits cell division

Question 30

What are the side effects of carboplatin?

Answer 30

Thrombocytopenia

Question 31

What are the side effects of paclitaxel?

Answer 31

Neuropathy, neutropenia, leukopenia

Question 32

When is intraperitoneal chemo indicated?

Answer 32

For optimally cytoreduced patients (less than 1 cm of residual disease after initial surgery)

Question 33

At what stage is there a big drop off in survival of ovarian cancer?

Answer 33

After stage II--goes from 75% to 25%

Question 34

What, generally, is the treatment for ovarian cancer?

Answer 34

Abdominal hysterectomy, and adjuvant IV carbo/taxol

Question 35

What is the most curable malignancy of GYN? Why (3)?

Answer 35

Gestational trophoblastic disease b/c: - Early detection - Modern chemo - Accurate and reliable bHCG

Question 36

What, generally, is gestational trophoblastic disease?

Answer 36

Abnormal cellular proliferation of placenta

Question 37

What are the 4 entities that GTD encompasses?

Answer 37

- Hydatidiform mole - Invasive mole - Choriocarcinoma - Placental site trophoblastic neoplasia

Question 38

What is the imaging modality of choice for evaluation for a GTD?

Answer 38

US

Question 39

What are the s/sx of GTD? (3)

Answer 39

- 1st trimester bleeding - elevated hCG levels - size big for dates

Question 40

What is toxemia? When does this happen in GTD?

Answer 40

Preeclampsia Happens prior to 24 weeks gestation

Question 41

What percent of molar pregnancies are invasive molar pregnancy?

Answer 41

5-10%

Question 42

What is the classical US finding of GTDs?

Answer 42

"Snowstorm" image

Question 43

What is the most common form of GTDs?

Answer 43

Molar pregnancies

Question 44

What percent of GTDs arise from molar pregnancies?

Answer 44

50%

Question 45

What percent of GTDs arise from miscarriages or ectopics?

Answer 45

25%

Question 46

What percent of GTDs arise from term or preterm pregnancies?

Answer 46

25%

Question 47

What are the general work up for a GTD?

Answer 47

- CXR for mets | - CBC, CMP, clotting

Question 48

Why should LFTs be obtained for GTDs?

Answer 48

Assess problems with chemo given

Question 49

What is the treatment of a molar pregnancy? (3)

Answer 49

- Evacuate the uterus - Monitor hCG - Chemo

Question 50

What is a uterine evacuation?

Answer 50

Procedure done under general anesthesia, where the cervix is dilated, and a large bore suction curette vacuums out

Question 51

What is the most common complication of uterine evacuation?

Answer 51

Significant Blood loss

Question 52

What is the issue of having an epidural prior to performing a uterine evacuation?

Answer 52

Harder to control blood pressure with the significant blood loss

Question 53

Why is oxytocin used with uterine evacuations?

Answer 53

Induces uterine contraction to aid in expulsion

Question 54

What are the common sites of mets for GTDs?

Answer 54

Lung Vagina Liver Brain

Question 55

What do plateaued or rising levels of hCG post uterine evacuation indicate?

Answer 55

Invasive mole

Question 56

When is the risk for GTDs increased?

Answer 56

extremes of age

Question 57

What is the risk of having another molar pregnancy if she's already had one? More than 1?

Answer 57

1: 100 if had one 1: 4 if have more than 1