Ovarian Cancer Flashcards by Kerry Hendrie

List the main groups of ovarian pathology

Cysts
Endometriosis
Tumours

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Ovarian cysts usually resolve on their own. True/False?

True

Typically over a few months

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List types of ovarian cysts

Follicular
Luteal
Endometriotic
Epithelial
Mesothelial

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What are the main clinical signs of endometriosis?

Pelvic inflammation
Infertility
Pain

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List some common sites of endometriosis

Ovary
Pouch of Douglas
Peritoneum
Cervix, vulva, vagina
Bladder
Bowel

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What is the typical appearance of endometriosis in the ovary?

Chocolate cysts
Peritoneal spots or nodules
Fibrous adhesions

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List complications of endometriosis

Cyst formation
Ectopic pregnancy
Endometrial carcinoma
Adhesions
Infertility

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List the main classifications of ovarian tumours and their relative prevalence

Epithelial (55-70%)
Germ cell (15-20%)
Sex cord/ stromal
Metastatic
Miscellaneous

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List the main epithelial ovarian tumours

Serous
Mucinous
Endometrioid
Clear cell
Brenner
Undifferentiated carcinoma

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What is the precursor for high-grade serous carcinoma of the ovary?

Serous tubal intraepithelial carcinoma (STIC)

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Which ovarian cancers are associated with endometriosis?

Endometrioid

Clear cell carcinoma

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Most endometrioid cancer is low-grade. True/False?

True

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What syndrome is associated with endometrioid cancer?

Lynch syndrome

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Diagnosis of epithelial tumours is often made using what type of fluid?

Ascitic fluid

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What is Brenner tumour?

Transitional cell epithelium tumour that is usually benign

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List the main germ cell tumours that can occur the ovary

Teratoma (mature or immature)
Dysgerminomas
Yolk sac tumour
Choriocarcinoma
Mixed germ cell tumour

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What is the most common germ cell tumour?

Mature benign cystic teratoma (95%)

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What is the most common malignant germ cell tumour? Who does it typically affect?

Dysgerminomas

Children and young woman

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List the main sex cord/stromal tumours

Fibroma/thecoma
Granulosa cell tumour
Sertoli-Leydig cell tumours

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Sex cord/stromal tumours are associated with an increase in which sex harmone?

Oestrogen

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What are the commonest sites that metastasise to the ovary?

Stomach
Colon
Breast
Pancreas

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Describe FIGO stage I of ovarian cancer

IA: one ovary
IB: both ovaries
IC: ovary with rupture/spill

Describe FIGO stage II of ovarian cancer

IIA: extension to uterus/fallopian tube
IIB: extension to other pelvic intraperitoneal structure

Describe FIGO stage III of ovarian cancer

IIIA: retroperitoneal lymph node metastasis
IIIB: peritoneal metastasis beyond pelvis up to 2cm
IIIC: peritoneal metastasis beyond pelvic over 2cm

Describe FIGO stage IV of ovarian cancer

IV: distant metastasis

Stae the name for the type of pelvic inflammatory disease occuring in the fallopian tubes

Salpingitis

What emergency condition should be considered in any female of reproductive age with amenorrhea and acute hypotension or an acute abdomen?

Ectopic pregnancy

A smear test can pick up ovarian cancer. True/False?

False | 1 in 3 believe it does though

Which BRCA mutation (1 or 2) is more associated with ovarian cancer? List other risk factors

``` BRCA1 (40%) BRCA2 (18%) >50yo Nulliparity Delayed pregnancy FHx of breast or ovarian cancer ```

Ovarian cancer often presents early with red flag symptoms. True/False?

False | Prevents late with non-specific symptoms (60%)

List some non-specific clinical features of ovarian cancer

``` Ascites/persistent bloating Pelvic mass, pelvic/abdominal pain Bladder dysfunction Pleural effusion Breathlessness Difficulty eating, feeling full quickly ```

Ovarian cancer can commonly be asymptomatic. True/False?

False | Rarely asymptomatic with almost always abdominal bloating/distention

What is the BEAT acronym to help raise awareness for ovarian cancer?

Bloating Eating less, feeling full Abdominal pain Tell GP!

How is ovarian cancer screened for?

It isn't! | High-risk women are identified and investigated, though

What should we offer women with BRCA mutations?

Prophylactic oophorectomy and removal of fallopian tubes

What marker is used in the diagnosis of ovarian cancer?

CA 125

Raised CA 125 alone is enough to diagnose ovarian cancer. True/False?

False | Can be raised in other things (e.g. endometriosis) so need ultrasound, cytology of fluid as well

What is the gold standard investigation for diagnosing ovarian cancer?

Pathology specimen from CT-guided biopsy or laparoscopic biopsy

State the calculation for "risk of malignancy index" for ovarian cancer

Ultrasound score x menopausal score x CA125 level

How many points on the "risk of malignancy index" for ovarian cancer is enough to refer to secondary care?

Score greater than 200

What are the ultrasound features looked out for in ovarian cancer that are involved in the "risk of malignancy index"?

``` Multilocular cysts Solid areas Bilateral lesions Ascites Intra-abdominal mass ```

What are the main methods of metastases of ovarian cancer?

Transcoelomic spread (peritoneal) Haematogenous (liver, lungs, brain if late) Lymphatic

List the main treatment options for ovarian cancer

Surgery | Chemotherapy + surgery

In women with low-grade ovarian cancer, optimal surgical staging should be done by doing what?

Biopsies of peritoneal lesions Infracolic omentectomy Iliac, para-aortic lymph node sampling

In advanced ovarian cancer, what should be given prior to surgery?

Neoadjuvant chemotherapy

What are the main chemotherapy agents used for ovarian cancer?

Carboplatin (1st line) | Paclitaxel (more side-effects)

What chemotherapy should be offered in those with relapsing platinum-sensitive ovarian cancer?

Platinum-based combination with paclitaxel, PLDH or gemcitabine

What therapy can be used for platinum-resistant ovarian cancer?

Hormonal therapy (tamoxifen, letrozole)

In the absence of symptoms, should CA125 levels be measured during followup for ovarian cancer?

Not routinely monitored as won't benefit with early chemotherapy

Epithelial cell tumours usually occurs in what age group?

Older women | 50-70s

Germ cell and sex cord tumours usually occur in what age group?

Younger women | 30s-50s

What is the first-line treatment for 1A/1B stage disease?

Comprehensive surgical staging

What is the first-line treatment for 1C stage disease?

Comprehensive surgical staging + chemotherapy

What is the first-line treatment for stage II,III or IV stage disease?

IV chemotherapy (platinum sensitive or platinum resistant)