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y3 obs and gynae > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

1
Q

List the main groups of ovarian pathology

A

Cysts
Endometriosis
Tumours

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2
Q

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

A

True

Typically over a few months

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3
Q

List types of ovarian cysts

A 
Follicular
Luteal
Endometriotic
Epithelial
Mesothelial
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4
Q

What are the main clinical signs of endometriosis?

A

Pelvic inflammation
Infertility
Pain

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5
Q

List some common sites of endometriosis

A 
Ovary
Pouch of Douglas
Peritoneum
Cervix, vulva, vagina
Bladder
Bowel
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6
Q

What is the typical appearance of endometriosis in the ovary?

A

Chocolate cysts
Peritoneal spots or nodules
Fibrous adhesions

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7
Q

List complications of endometriosis

A 
Cyst formation
Ectopic pregnancy
Endometrial carcinoma
Adhesions
Infertility
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8
Q

List the main classifications of ovarian tumours and their relative prevalence

A 
Epithelial (55-70%)
Germ cell (15-20%)
Sex cord/ stromal
Metastatic
Miscellaneous
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9
Q

List the main epithelial ovarian tumours

A 
Serous
Mucinous
Endometrioid
Clear cell
Brenner
Undifferentiated carcinoma
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10
Q

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

A

Serous tubal intraepithelial carcinoma (STIC)

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11
Q

Which ovarian cancers are associated with endometriosis?

A

Endometrioid

Clear cell carcinoma

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12
Q

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

A

True

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13
Q

What syndrome is associated with endometrioid cancer?

A

Lynch syndrome

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14
Q

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

A

Ascitic fluid

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15
Q

What is Brenner tumour?

A

Transitional cell epithelium tumour that is usually benign

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16
Q

List the main germ cell tumours that can occur the ovary

A 
Teratoma (mature or immature)
Dysgerminomas
Yolk sac tumour
Choriocarcinoma
Mixed germ cell tumour
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17
Q

What is the most common germ cell tumour?

A

Mature benign cystic teratoma (95%)

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18
Q

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

A

Dysgerminomas

Children and young woman

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19
Q

List the main sex cord/stromal tumours

A

Fibroma/thecoma
Granulosa cell tumour
Sertoli-Leydig cell tumours

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20
Q

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

A

Oestrogen

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21
Q

What are the commonest sites that metastasise to the ovary?

A

Stomach
Colon
Breast
Pancreas

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22
Q

Describe FIGO stage I of ovarian cancer

A

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

23
Q

Describe FIGO stage II of ovarian cancer

A

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

24
Q

Describe FIGO stage III of ovarian cancer

A

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

25
Q

Describe FIGO stage IV of ovarian cancer

A

IV: distant metastasis

26
Q

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

A

Salpingitis

27
Q

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

A

Ectopic pregnancy

28
Q

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

A

False

1 in 3 believe it does though

29
Q

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

A 
BRCA1 (40%)
BRCA2 (18%)
>50yo
Nulliparity
Delayed pregnancy
FHx of breast or ovarian cancer
30
Q

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

A

False

Prevents late with non-specific symptoms (60%)

31
Q

List some non-specific clinical features of ovarian cancer

A 
Ascites/persistent bloating
Pelvic mass, pelvic/abdominal pain
Bladder dysfunction
Pleural effusion
Breathlessness
Difficulty eating, feeling full quickly
32
Q

Ovarian cancer can commonly be asymptomatic. True/False?

A

False

Rarely asymptomatic with almost always abdominal bloating/distention

33
Q

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

A

Bloating
Eating less, feeling full
Abdominal pain
Tell GP!

34
Q

How is ovarian cancer screened for?

A

It isn’t!

High-risk women are identified and investigated, though

35
Q

What should we offer women with BRCA mutations?

A

Prophylactic oophorectomy and removal of fallopian tubes

36
Q

What marker is used in the diagnosis of ovarian cancer?

A

CA 125

37
Q

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

A

False

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

38
Q

What is the gold standard investigation for diagnosing ovarian cancer?

A

Pathology specimen from CT-guided biopsy or laparoscopic biopsy

39
Q

State the calculation for “risk of malignancy index” for ovarian cancer

A

Ultrasound score x menopausal score x CA125 level

40
Q

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

A

Score greater than 200

41
Q

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

A 
Multilocular cysts
Solid areas
Bilateral lesions
Ascites
Intra-abdominal mass
42
Q

What are the main methods of metastases of ovarian cancer?

A

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

43
Q

List the main treatment options for ovarian cancer

A

Surgery

Chemotherapy + surgery

44
Q

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

A

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

45
Q

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

A

Neoadjuvant chemotherapy

46
Q

What are the main chemotherapy agents used for ovarian cancer?

A

Carboplatin (1st line)

Paclitaxel (more side-effects)

47
Q

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

A

Platinum-based combination with paclitaxel, PLDH or gemcitabine

48
Q

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

A

Hormonal therapy (tamoxifen, letrozole)

49
Q

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

A

Not routinely monitored as won’t benefit with early chemotherapy

50
Q

Epithelial cell tumours usually occurs in what age group?

A

Older women

50-70s

51
Q

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

A

Younger women

30s-50s

52
Q

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

A

Comprehensive surgical staging

53
Q

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

A

Comprehensive surgical staging + chemotherapy

54
Q

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

A

IV chemotherapy (platinum sensitive or platinum resistant)

y3 obs and gynae (44 decks)

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