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OB/GYN > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

1
Q

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

A
  1. Uterine

2. Ovarian

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2
Q

What is the most lethal gyn cancer?

A

Ovarian cancer

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3
Q

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

A

True

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4
Q

What is the median age at diagnosis for ovarian cancer?

A

63 years

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5
Q

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

A

Age

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6
Q

Do BRCA1/2 increase the incidence of ovarian cancer

A

Yes

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7
Q

Do oral contraceptives decrease the rate of ovarian cancer?

A

Yes

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8
Q

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

A

Not proven to be effective as a screening technique

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9
Q

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

A

Not proven to be effective–none specific

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10
Q

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

A

May be a corpus luteum cyst

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11
Q

What are the s/sx of ovarian cancer?

A
  • Bloating
  • Increased abdominal girth
  • Pelvic pain
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12
Q

What are the PE findings of ovarian cancer?

A
  • Ascites

- Adnexal lesions

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13
Q

What is the most common adnexal mass in young women?

A

Benign cysts

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14
Q

What is the most common adnexal mass in postmenopausal women?

A

More likely to be malignant than premenopausal women

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15
Q

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

A
  • Ectopic Pregnancy
  • Cysts
  • ruptured ovarian abscess
  • Ovarian torsion
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16
Q

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

A
  • Breast exam, DRE, mammography
  • CA-125
  • TVUS
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17
Q

What is the positive predictive value for adnexal US Imaging?

A

Low

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18
Q

What are excrescences?

A

Irregularities on the surface

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19
Q

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

A

Benign

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20
Q

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

A

Excessive estrogen production

Call-exner bodies

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21
Q

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

A

q 6 months indefinitely

3-5 years get a CT

Inhibin A and B

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22
Q

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

A

b-hCG, LDH, AFP

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23
Q

What is the tumor marker for embryonal carcinoma?

A

AFP

bhCG

24
Q

What is the tumor marker for endodermal sinus tumor?

A

AFP

25
Q

What is the tumor marker for granulosa cell tumors?

A

Inhibin

26
Q

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

A

Debulking–less than 1 cm in size

27
Q

What is the treatment for epithelial ovarian cancer?

A

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

28
Q

What is the MOA of carboplatin?

A

Binds and crosslinks DNA to prevent DNA synthesis

29
Q

What is the MOA of paclitaxel?

A

binds to stable microtubules, and inhibits cell division

30
Q

What are the side effects of carboplatin?

A

Thrombocytopenia

31
Q

What are the side effects of paclitaxel?

A

Neuropathy, neutropenia, leukopenia

32
Q

When is intraperitoneal chemo indicated?

A

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

33
Q

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

A

After stage II–goes from 75% to 25%

34
Q

What, generally, is the treatment for ovarian cancer?

A

Abdominal hysterectomy, and adjuvant IV carbo/taxol

35
Q

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

A

Gestational trophoblastic disease b/c:

  • Early detection
  • Modern chemo
  • Accurate and reliable bHCG
36
Q

What, generally, is gestational trophoblastic disease?

A

Abnormal cellular proliferation of placenta

37
Q

What are the 4 entities that GTD encompasses?

A
  • Hydatidiform mole
  • Invasive mole
  • Choriocarcinoma
  • Placental site trophoblastic neoplasia
38
Q

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

A

US

39
Q

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

A
  • 1st trimester bleeding
  • elevated hCG levels
  • size big for dates
40
Q

What is toxemia? When does this happen in GTD?

A

Preeclampsia

Happens prior to 24 weeks gestation

41
Q

What percent of molar pregnancies are invasive molar pregnancy?

A

5-10%

42
Q

What is the classical US finding of GTDs?

A

“Snowstorm” image

43
Q

What is the most common form of GTDs?

A

Molar pregnancies

44
Q

What percent of GTDs arise from molar pregnancies?

A

50%

45
Q

What percent of GTDs arise from miscarriages or ectopics?

A

25%

46
Q

What percent of GTDs arise from term or preterm pregnancies?

A

25%

47
Q

What are the general work up for a GTD?

A
  • CXR for mets

- CBC, CMP, clotting

48
Q

Why should LFTs be obtained for GTDs?

A

Assess problems with chemo given

49
Q

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

A
  • Evacuate the uterus
  • Monitor hCG
  • Chemo
50
Q

What is a uterine evacuation?

A

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

51
Q

What is the most common complication of uterine evacuation?

A

Significant Blood loss

52
Q

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

A

Harder to control blood pressure with the significant blood loss

53
Q

Why is oxytocin used with uterine evacuations?

A

Induces uterine contraction to aid in expulsion

54
Q

What are the common sites of mets for GTDs?

A

Lung
Vagina
Liver
Brain

55
Q

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

A

Invasive mole

56
Q

When is the risk for GTDs increased?

A

extremes of age

57
Q

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

A

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

OB/GYN (33 decks)

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