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RGU 2 > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

1
Q

How common are ovarian masses in postmenopausal women?

A

20%

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2
Q

What is the chance that you will develop a palpable cyst as a menstruating woman?

A

10%

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3
Q

What is the lifetime risk of a woman developing ovarian cancer?

A

1.7% (25,000 women each year)

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4
Q

How many women will get breast cancer each year?

A
  • 180,000
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5
Q

What are some ovarian cancer risk factors?

A
  • nulliparity
  • age
  • early onset menses
  • smoking
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6
Q

What should be on your differential for ovarian cancer?

A
  • ovarian
  • uterine
  • tubal
  • colon
  • appendix
  • retroperitoneal
  • bladder
  • lymphoma
  • infectious
  • neurologic
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7
Q

What cells in the ovary give rise to pluripotent stem cells?

A
  • oocyte (germ cell tumors)
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8
Q

What are the 3 possible types of ovarian tumors?

A
  1. epithelial surface (MOST)
  2. sex chord stromal
  3. germ cell
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9
Q

What should we use to work up a pt with an incidental ovarian mass?

A
  • pelvic ultrasound (transvaginal)
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10
Q

What percent of ovarian cancers are stage 1 (confined to one ovary)?

A

10%

*this has not changed in 40 years.

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11
Q

Is ovarian cancer relatively asymptomatic in EARLY stages?

A

YES

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12
Q

*** What symptoms are associated with ovarian cancer?

A
  • BLOATING
  • NAUSEA
  • LOWER ABDOMINAL discomfort
  • often dismissed by pt and physician.
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13
Q

What are LATER signs of ovarian cancer presentation?

A
  • abdominal tenderness
  • swelling
  • ascites
  • bowel obstruction
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14
Q

How accurate is US for the detection of benign vs malignant ovarian mass detection?

A
  • depends on user (subjective)
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15
Q

*** What are the signs of a BENIGN mass on ultrasound?

A
  • smooth cyst

- small size

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16
Q

*** What are the features of a MALIGNANT mass on ultrasound?

A
  • larger size
  • thick septations (greater than 3 mm)
  • sold areas (greater than 7 mm)
  • papillations, excrescences
  • growth
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17
Q

Is MRI sensitive for detecting ovarian masses?

A

YES, but it is very expensive and uncomfortable to endure.

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18
Q

What serum marker can we use in surveillance and treatment planning of ovarian cancer pts?

A
  • CA-125= nonspecific glycoprotein.
  • NOT a good diagnostic marker bc pregnancy, menses, pancreatitis, appendicitis, colitis, fibroids (leiomyomas), or any other signs of inflammation cause in the abdomen.
19
Q

Will CA-125 be elevated in most MUCINOUS carcinomas?

A

NO, only 20%.

*it will be elevated in most SEROUS carcinomas however.

20
Q

Is CA-125 useful in screening patients for ovarian cancer?

A

NO

21
Q

Is human epididymis protein 4 (HE-4) a good serum marker in screening for ovarian cancer?

A

NO

22
Q

Is OVA1 (multivariate index serum assay) useful in screening for ovarian cancer?

A

NO, but increases negative predictive value (bad specificity however).

23
Q

** What are the 5 types of epithelial ovarian tumors?

A
  1. SEROUS (look like the fallopian tube); look for psammoma bodies (calcium and magnesium).
  2. MUCINOUS (looks like endocervical or intestinal lining); usually large and unilateral.
  3. ENDOMETRIOID (associated with concurrent endometrial cancers); younger patients.
  4. CLEAR CELL (very aggressive, associated with endometriosis and endometrial cancer); “hob-nail” appearance.
  5. BRENNER (transitional cell epithelium, solid, small, and “coffee bean nuclei”); very rare.
24
Q

How do we treat SEROUS ovarian cancer?

A
  • surgery (debulking)
25
Q

With what does lymph node spread always correlate?

A
  • arterial supply
26
Q

What are the 2 blood supplies to the ovaries?

A
  1. ovarian vessels (gonadal arteries) from the aorta

2. uterine artery from internal iliac

27
Q

What surrounding structures should we check with ovarian cancer for staging?

A
  • lymph nodes
  • uterus
  • fallopian tubes
  • ovaries
  • cervix
  • peritoneum
  • omentum
28
Q

What chemotherapies are used in ovarian cancer?

A
  • carboplatin and cisplatin
  • taxanes (paclitaxel)
  • VEGF inhibitors
29
Q

What are some genetic risks for ovarian cancer?

A
  • BRCA 1 (40%)
  • BRCA 2 (20%)
  • Lynch (MMR)
  • RAD51 C and D
30
Q

Who should get genetic tested for ovarian cancer?

A
  • any SEROUS cancer
  • early age diagnosis
  • multiple cancers, same pt
  • multiple family members
  • rare tumors (male breast)
31
Q

** What is the most common benign germ cell tumor in women?

A
  • cystic teratoma

* usually younger girls

32
Q

How do girls present with cystic teratomas (benign germ cell tumor)?

A
  • pain, fever, rapidly growing ovarian mass
33
Q

What serum marker is elevated in dysgerminomas (germ cell tumor)?

A

LDH

34
Q

What serum markers are elevated in embryonal carcinomas (germ cell tumor)?

A
  • AFP and B-hCG
35
Q

May some dysgerminomas be associated with gonadal dysgenesis?

A

YES (Turner’s syndrome)

36
Q

Can almost all germ cell tumors have fertility sparing surgery?

A
  • YES

* extremely sensitive to bleomycin and cisplatin

37
Q

What is the defining feature for grading immature teratomas?

A

neural cells

38
Q

*** What do endodermal sinus tumors (yolk sac tumors) secrete?

A

AFP

*look for SCHILLER-DUVAL bodies (glomerulus-like structures)

39
Q

With what are stromal tumors associated?

A
  • elevated levels of testosterone or estrogen
40
Q

What marker is useful in granulosa cell tumors (Sex cord-stromal type)?

A
  • inhibin
41
Q

*** What histology finding will you see with granulosa cell tumors (Sex cord-stromal type)?

A

Call-Exner bodies

42
Q

Are thecoma-fibromas (sex cord-stromal tumor) benign?

A

YES

43
Q

*** With what are fibromas (sex cord-stromal tumor) associated?

A
  • MEIGS syndrome= ascites, pleural effusion, and ovarian tumor

RGU 2 (24 decks)

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