Ovarian Cancer Flashcards
How common are ovarian masses in postmenopausal women?
20%
What is the chance that you will develop a palpable cyst as a menstruating woman?
10%
What is the lifetime risk of a woman developing ovarian cancer?
1.7% (25,000 women each year)
How many women will get breast cancer each year?
- 180,000
What are some ovarian cancer risk factors?
- nulliparity
- age
- early onset menses
- smoking
What should be on your differential for ovarian cancer?
- ovarian
- uterine
- tubal
- colon
- appendix
- retroperitoneal
- bladder
- lymphoma
- infectious
- neurologic
What cells in the ovary give rise to pluripotent stem cells?
- oocyte (germ cell tumors)
What are the 3 possible types of ovarian tumors?
- epithelial surface (MOST)
- sex chord stromal
- germ cell
What should we use to work up a pt with an incidental ovarian mass?
- pelvic ultrasound (transvaginal)
What percent of ovarian cancers are stage 1 (confined to one ovary)?
10%
*this has not changed in 40 years.
Is ovarian cancer relatively asymptomatic in EARLY stages?
YES
*** What symptoms are associated with ovarian cancer?
- BLOATING
- NAUSEA
- LOWER ABDOMINAL discomfort
- often dismissed by pt and physician.
What are LATER signs of ovarian cancer presentation?
- abdominal tenderness
- swelling
- ascites
- bowel obstruction
How accurate is US for the detection of benign vs malignant ovarian mass detection?
- depends on user (subjective)
*** What are the signs of a BENIGN mass on ultrasound?
- smooth cyst
- small size
*** What are the features of a MALIGNANT mass on ultrasound?
- larger size
- thick septations (greater than 3 mm)
- sold areas (greater than 7 mm)
- papillations, excrescences
- growth
Is MRI sensitive for detecting ovarian masses?
YES, but it is very expensive and uncomfortable to endure.
What serum marker can we use in surveillance and treatment planning of ovarian cancer pts?
- 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.
Will CA-125 be elevated in most MUCINOUS carcinomas?
NO, only 20%.
*it will be elevated in most SEROUS carcinomas however.
Is CA-125 useful in screening patients for ovarian cancer?
NO
Is human epididymis protein 4 (HE-4) a good serum marker in screening for ovarian cancer?
NO
Is OVA1 (multivariate index serum assay) useful in screening for ovarian cancer?
NO, but increases negative predictive value (bad specificity however).
** What are the 5 types of epithelial ovarian tumors?
- SEROUS (look like the fallopian tube); look for psammoma bodies (calcium and magnesium).
- MUCINOUS (looks like endocervical or intestinal lining); usually large and unilateral.
- ENDOMETRIOID (associated with concurrent endometrial cancers); younger patients.
- CLEAR CELL (very aggressive, associated with endometriosis and endometrial cancer); “hob-nail” appearance.
- BRENNER (transitional cell epithelium, solid, small, and “coffee bean nuclei”); very rare.
How do we treat SEROUS ovarian cancer?
- surgery (debulking)
With what does lymph node spread always correlate?
- arterial supply
What are the 2 blood supplies to the ovaries?
- ovarian vessels (gonadal arteries) from the aorta
2. uterine artery from internal iliac
What surrounding structures should we check with ovarian cancer for staging?
- lymph nodes
- uterus
- fallopian tubes
- ovaries
- cervix
- peritoneum
- omentum
What chemotherapies are used in ovarian cancer?
- carboplatin and cisplatin
- taxanes (paclitaxel)
- VEGF inhibitors
What are some genetic risks for ovarian cancer?
- BRCA 1 (40%)
- BRCA 2 (20%)
- Lynch (MMR)
- RAD51 C and D
Who should get genetic tested for ovarian cancer?
- any SEROUS cancer
- early age diagnosis
- multiple cancers, same pt
- multiple family members
- rare tumors (male breast)
** What is the most common benign germ cell tumor in women?
- cystic teratoma
* usually younger girls
How do girls present with cystic teratomas (benign germ cell tumor)?
- pain, fever, rapidly growing ovarian mass
What serum marker is elevated in dysgerminomas (germ cell tumor)?
LDH
What serum markers are elevated in embryonal carcinomas (germ cell tumor)?
- AFP and B-hCG
May some dysgerminomas be associated with gonadal dysgenesis?
YES (Turner’s syndrome)
Can almost all germ cell tumors have fertility sparing surgery?
- YES
* extremely sensitive to bleomycin and cisplatin
What is the defining feature for grading immature teratomas?
neural cells
*** What do endodermal sinus tumors (yolk sac tumors) secrete?
AFP
*look for SCHILLER-DUVAL bodies (glomerulus-like structures)
With what are stromal tumors associated?
- elevated levels of testosterone or estrogen
What marker is useful in granulosa cell tumors (Sex cord-stromal type)?
- inhibin
*** What histology finding will you see with granulosa cell tumors (Sex cord-stromal type)?
Call-Exner bodies
Are thecoma-fibromas (sex cord-stromal tumor) benign?
YES
*** With what are fibromas (sex cord-stromal tumor) associated?
- MEIGS syndrome= ascites, pleural effusion, and ovarian tumor
