Ovarian Cancer Flashcards
What are the top two most common gyn cancers in the developed world?
- Uterine
2. Ovarian
What is the most lethal gyn cancer?
Ovarian cancer
True or false: most of the ovarian cancers are discovered at a late stage
True
What is the median age at diagnosis for ovarian cancer?
63 years
What is the most important risk factor for the development of ovarian cancer?
Age
Do BRCA1/2 increase the incidence of ovarian cancer
Yes
Do oral contraceptives decrease the rate of ovarian cancer?
Yes
What is the role of vaginal US in the prevention of ovarian cancer?
Not proven to be effective as a screening technique
What is the role of Ca 125 in the detection of ovarian cancer? Why?
Not proven to be effective–none specific
Why should you delay further workup for an ovarian mass if the woman is in the luteal phase of her menstrual cycle?
May be a corpus luteum cyst
What are the s/sx of ovarian cancer?
- Bloating
- Increased abdominal girth
- Pelvic pain
What are the PE findings of ovarian cancer?
- Ascites
- Adnexal lesions
What is the most common adnexal mass in young women?
Benign cysts
What is the most common adnexal mass in postmenopausal women?
More likely to be malignant than premenopausal women
What should be r/o before suspecting ovarian cancer in premenopausal women? (4)
- Ectopic Pregnancy
- Cysts
- ruptured ovarian abscess
- Ovarian torsion
What should be done in the workup of a postmenopausal woman for an adnexal mass?
- Breast exam, DRE, mammography
- CA-125
- TVUS
What is the positive predictive value for adnexal US Imaging?
Low
What are excrescences?
Irregularities on the surface
Are unilocular ovarian masses more likely to be benign or malignant?
Benign
What is the endocrine function of granulosa cell tumors? What is the classic histological finding of these?
Excessive estrogen production
Call-exner bodies
How often should women who are found to have an ovarian tumor be seen? How often should imaging be obtained? What labs?
q 6 months indefinitely
3-5 years get a CT
Inhibin A and B
What are the three tumor marker for malignant germ cell tumors?
b-hCG, LDH, AFP
What is the tumor marker for embryonal carcinoma?
AFP
bhCG
What is the tumor marker for endodermal sinus tumor?
AFP
What is the tumor marker for granulosa cell tumors?
Inhibin
What is cytoreductive surgery? When is this the optimal therapy?
Debulking–less than 1 cm in size
What is the treatment for epithelial ovarian cancer?
Removal of uterus, tubes, ovaries, omentum, pelvic and paraaortic nodes
What is the MOA of carboplatin?
Binds and crosslinks DNA to prevent DNA synthesis
What is the MOA of paclitaxel?
binds to stable microtubules, and inhibits cell division
What are the side effects of carboplatin?
Thrombocytopenia
What are the side effects of paclitaxel?
Neuropathy, neutropenia, leukopenia
When is intraperitoneal chemo indicated?
For optimally cytoreduced patients (less than 1 cm of residual disease after initial surgery)
At what stage is there a big drop off in survival of ovarian cancer?
After stage II–goes from 75% to 25%
What, generally, is the treatment for ovarian cancer?
Abdominal hysterectomy, and adjuvant IV carbo/taxol
What is the most curable malignancy of GYN? Why (3)?
Gestational trophoblastic disease b/c:
- Early detection
- Modern chemo
- Accurate and reliable bHCG
What, generally, is gestational trophoblastic disease?
Abnormal cellular proliferation of placenta
What are the 4 entities that GTD encompasses?
- Hydatidiform mole
- Invasive mole
- Choriocarcinoma
- Placental site trophoblastic neoplasia
What is the imaging modality of choice for evaluation for a GTD?
US
What are the s/sx of GTD? (3)
- 1st trimester bleeding
- elevated hCG levels
- size big for dates
What is toxemia? When does this happen in GTD?
Preeclampsia
Happens prior to 24 weeks gestation
What percent of molar pregnancies are invasive molar pregnancy?
5-10%
What is the classical US finding of GTDs?
“Snowstorm” image
What is the most common form of GTDs?
Molar pregnancies
What percent of GTDs arise from molar pregnancies?
50%
What percent of GTDs arise from miscarriages or ectopics?
25%
What percent of GTDs arise from term or preterm pregnancies?
25%
What are the general work up for a GTD?
- CXR for mets
- CBC, CMP, clotting
Why should LFTs be obtained for GTDs?
Assess problems with chemo given
What is the treatment of a molar pregnancy? (3)
- Evacuate the uterus
- Monitor hCG
- Chemo
What is a uterine evacuation?
Procedure done under general anesthesia, where the cervix is dilated, and a large bore suction curette vacuums out
What is the most common complication of uterine evacuation?
Significant Blood loss
What is the issue of having an epidural prior to performing a uterine evacuation?
Harder to control blood pressure with the significant blood loss
Why is oxytocin used with uterine evacuations?
Induces uterine contraction to aid in expulsion
What are the common sites of mets for GTDs?
Lung
Vagina
Liver
Brain
What do plateaued or rising levels of hCG post uterine evacuation indicate?
Invasive mole
When is the risk for GTDs increased?
extremes of age
What is the risk of having another molar pregnancy if she’s already had one? More than 1?
1: 100 if had one
1: 4 if have more than 1
