ovarian cancer

Question 1

Surface Epithelium tumors

Answer 1

Serous
Mucinous
Endometriod
Clear Cell
Transitional

Question 2

Sex Cord Stromal Tumors

Answer 2

Granulosa Cell
Thecoma
Fibroma
Seroli Leydig

Question 3

Germ Cell Tumors

Answer 3

Dysgerminoma
Yolk Sac
Embryonal Carcinoma
Choriocarcinoma
Teratoma

Question 4

What type of cancers are reduced due to salpingectomy?

Answer 4

Clear Cell and Endometriod primarily

Question 5

Risk Reducing BSO

Answer 5

decreased ovarian by 96% and Breast by 53%

Risk of primary peritoneal cancer after
salpingo-oophorectomy: 4%
 Occult ovarian cancer at the time of surgery:
2-17%

BRCA1 35-40
BRCA2 40-45

Can consider for other genes for ovarian ca like lynch

Question 6

Screening for high risk for ovarian cancer

Answer 6

CA 125 and U/S every 6 months

Question 7

Which ovarian cancer patients should have genetic testing

Answer 7

ALL

Question 8

ovarian cancer work-up

Answer 8

Most helpful imaging:
 Pelvic ultrasound
 CT abdomen/pelvis with PO and IV contrast
 Most helpful labs:
 CA-125, CA 19-9, CEA
 Inhibin B, HCG, AFP, LDH, testosterone (if younger, solid
mass, or hyperestrogenism/androgenism)

Question 9

Staging surgery for Ovary

Answer 9

􀀀 Vertical midline incision
􀀀 Obtain peritoneal cytology
􀀀 Intact tumor removal
􀀀 Complete abdominal exploration
􀀀 Removal of remaining ovaries, uterus, tubes
􀀀 Pelvic/para-aortic lymphadenectomy
􀀀 Omentectomy
􀀀 Random peritoneal biopsies
􀀀 Appendectomy (particularly if mucinous)

Question 10

Very Basic Ovary Staging

Answer 10

1- overy
2- Pelvis
3- beyond pelvis (nodes or microscopic mets)
4- Distant

Question 11

Chemotherapy for ovarian

Answer 11

Stage 1 grade 1- observe 
stage 1 grade 2- observe or chemo
Stage 1 grade 3- Carbo/taxol 3-6 cycles
Stage 1c- carbo/taxol 3-6 cycles 
Stage II-IV - Carbo/taxol 6-8 cycles
Neo- 3-4 cycles (surgery) 3-4 cycles

Question 12

What is the response rate for chemo?

Answer 12

75-80% respond to chemo

Question 13

What is platinum resistance?

Answer 13

recurrence <6 months

Question 14

What are maintenance therapy options?

Answer 14

PARP inhibitors (DNA repair)- genetic mutations
 Bevacizumab (VEGF antibody)
 Pazopanib

Question 15

Surveillance with ovarian Cancer

Answer 15

Visit with exam every 3 months x 2 years, 6 months x 3 yrs
 CA-125 optional
 Imaging if concern for recurrence

Question 16

Low Grade Serious

Answer 16

Similar progression free survival (19 months), but longer
overall survival (82-99 months)
 More chemotherapy resistance
 Treat with (aggressive) surgery
 Hormonal therapy (GnRH, aromatase inhibitors,
progesterones)

Question 17

Borderline Work-up

Answer 17

Surgical staging
 25-30% with extra-ovarian
disease
 Up to 25% will have invasive
disease on final path
 Peritoneal biopsies and omentectomy
 Oophorectomy
 Appendectomy if mucinous
 Lymphadenectomy “case by case”

Question 18

Borderline Treatment

Answer 18

Excellent survival > 98%
 Even if no invasion or non-invasive implants, recurrence
is possible (~30% after fertility sparing surgery)
 Surveillance is needed
 Visits with exam every 3-6 months
 Pelvic ultrasound if fertility sparing surgery – every 6-12
months?
 CA-125?
 Unsure value of completion hysterectomy/USO after
childbearing, may consider

Question 19

Immature Teratoma

Answer 19

20% of primitive germ cell tumors (3% of
teratomas)
 Contains immature neural elements/tubules
 Only GCT that is graded
 Tumor marker: none (sometimes AFP)
 Surgery – USO and staging
 Adjuvant therapy
 Early stage (IA): none required
 All other stages: Bleomycin/etoposide/cisplatin
 Overall survival 70-80%

Question 20

Dysgerminoma

Answer 20

Most common malignant germ cell tumor (50%)
 Bilateral in 15%
 Tumor marker is LDH (8% HCG, no AFP)
 Abnormal karyotype in 5% of patients (associated
with gonadoblastoma)
 Surgical management includes:
 USO and staging
 BSO if abnormal karyotype (gonadoblastoma)
 Debulking of uncertain value
Adjuvant therapy for advanced disease
 Chemotherapy (BEP)

Question 21

Endodermal Sinus Tumor

Yolk sac tumor

Answer 21

20% of germ cell tumors
 Median age 18 years
 Tumor marker is AFP
 Schiller-Duval bodies on path (central capillary surrounded by
connective tissue and layer of columnar cells)
 Surgical goal is diagnosis
 All patients will require adjuvant treatment
 Bleomycin/etoposide/cisplatinum or radiation therapy
 Poor survival (even with early stage)

Question 22

Embryonal, Choriocarcinoma,

Polyembryoma

Answer 22

 Very rare cancers
 Tumor marker is hCG
 Poor survival due to late diagnosis
 Treat with BEP or GTN regimen

Question 23

Granulosa Cell Tumor Markers

Answer 23

Estrogen, Inhibin, Testosterone, AMH

Call-Exner Bodies

Question 24

Sertoli Leydig

Answer 24

AFP, Estrogen, Inhibin, Testosterone >2.5x normal, Androsteindione, DHEA

may secrete renin (hypertension, hypokalemia)

Reinke Crystals

Question 25

Treatment for sex-cord stromal

Answer 25

TAH/BSO or fertility
sparing surgery, omentectomy and biopsies,
and/or complete tumor debulking; lymph
node involvement is rare

BEP or carbo/taxol

Do get an endometrial biopsy

Question 26

Meigs syndrome

Answer 26

Solid adnexal mass
Pleural Effusions
Ascites

• usually fibroma (benign)