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Skin Radiation therapy > Ovarian cancer > Flashcards

Ovarian cancer Flashcards

1
Q

ovarian cancer is the most _____gyne cancer

A

deadly

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2
Q

ovarian cancer is usually diagnosed _____

A

late

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3
Q

ovarian cancer is most common at what age

A

60-70

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4
Q

most significant factors for the development of ovarian cancer

A

+ age and family history

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5
Q

all risk factors ovarian cancer

A 
little is known 
null parity
early menarche
1st child after 35
smoking 
immunosuppression 
late menopause
jewish descent (higher incidence of BRCA1&2)
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6
Q

MOST Ovarian cancers present with what type of spread

A

80% of pts present w/ abdominal cavity involvement- cells exfoliate into the fluid in the peritoneal cavity (peritoneal seeding)

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7
Q

areas of distant mets ovarian cancer

A

Distant mets to liver, lung, diaphragm, bladder, colon

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8
Q

natural history of ovarian cancer

A

Growth occurs in the ovary, spreading through the cyst wall onto the surface, spreads to the fallopian tubes, uterus, colon
Transcoelomic Spread: Across the peritoneal cavity resulting in the classic appearance of multiple seedlings

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9
Q

most common presenting stage in ovarian cancer

A

stage 3C

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10
Q

most common signs of ovarian cancer

A

abdo & pelvic pain, abdo distention and vague GI symptom

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11
Q

how s diagnosis and staging determined in ovarian cancer

A

determined via surgery- laparotomy (surgical investigation via a small incision in the lower abdo

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12
Q

what is effective in determining ovarian cancer in late stages but not early stages

A

ca-125 the levels are elevated in late stage but to early stage

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13
Q

how can early stage ovarian cancer be determined

A

Early stage cancers can be detected during routine exams as a palpable asymptomatic mass

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14
Q

peritoneal washing

A

used in the diagnosis of ovarian cancer ytologic evaluation of peritoneal fluid and examination and biopsy of peritoneal surfaces

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15
Q

most common histology of ovarian cancer

A

epithelial

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16
Q

staging ovarian cancer

A

Stage I: Confined to the ovaries
A) One ovary
B) Both ovaries
C) One or both ovaries with a ruptured capsule, tumour on ovarian surface, malignant cells in ascites or peritoneal washings
Stage II: One or both ovaries w/ pelvic extension
A) Extension or implants on uterus, fallopian tubes
B) Extension or implants onto other pelvic structures
Stage III: One or both ovaries w/ spread to the peritoneum or mets to retroperitoneal l/n
A) Microscopic peritoneal mets beyond the pelvis or limited to the pelvis w/ extension to the small bowel or omentum
B) Macroscopic perioneal mets beyond pelvis <2cm in size
C) Macroscopic perioneal mets beyond pelvis >2cm in size
Stage IV: Distant mets
**BASED ON FIGO STAGING **

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17
Q

INDICATIONS FOR SURGERY in the treatment of ovarian cancer

A

used as sole treatment with early disease
Maybe used w/ postop chemo for more extensive disease
Mainly used to debulk as much as possible as disease is typically extensive at time of diagnosis

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18
Q

surgeries for ovarian cancer

A 
Total abdominal hysterectomy
Bilateral salpingo-oopherectomy
Omentectomy w/ paraortic l/n
Liver &amp; peritoneal surface examination
Cytoreductive surgery (debulking surgery
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19
Q

indications for chemo in ovarian treatment

A

Currently the mainstay for treatment following surgery
May be used for inoperable pts
Postop for high grade stage 1 and stages 2-3

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20
Q

chemo agents and methods of administratuin

A

Single agent or multiagent
Platinum compounds and paclitaxel typically used
IV or intraperitoneal chemo

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21
Q

indications for XRT in ovarian cancer

A

Now rarely used due to severe side effects and better tumour control is seen with chemo

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22
Q

CT scanning limits for ovarian cancer

A

Sup Border – L3/L4

Inf Border – 5cm inf from ischial tuberosities

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23
Q

field borders for extended SSD ovarian treatment

A 
Whole Abdo &amp; Pelvis:
Sup= 2cm sup to dome of diaphragm
Inf= Encompass obturator foramen
Lat= Clear peritoneum by 2cm
Pelvic Boost:
Sup= L5/S1 to include pelvic l/n OR T12/L1 when paraortics are included
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24
Q

phases for ovarian cancer extended SSD TX

A

Phase I:
2300cGy/23 to whole abdo with a concurrent pelvic boost of 1150cGy/23
Posterior 5 HVL renal shielding used to limit the renal dose, brought in at 1500cGy
Phase 2:
Pelvic boost of 1050cGy/7
Total dose of 45Gy/30

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25
Q

stage 1 ovarian cancer tx

A

Stage I: Primary surgery (TAH BSO) will suffice, may use adjuvant chemo if high risk

26
Q

stage 2 ovarian cancer tx

A

Stage II: Neoadjuvant surgery to debulk, followed by primary chemo OR WART (although not typically used)

27
Q

stage 3 ovarian cancer tx

A

Stage III: Neoadjuvant surgery to debulk, followed by primary chemo or WART (although not typically used)

28
Q

stage 4 ovarian cancer tx

A

Stage IV: Palliative chemo or XRT

29
Q

prognostic indicators ovarian cancer

A

Stage, volume of post-op residual disease and tumour grade are all important factors

30
Q

drainage ovarian cancer

A

par aortic LN—cisternal chill (lumbar trunk)–thoracic duct
Paraortics most commonly involved then pelvic LN
rarely: external iliac and inguinal LN can be involved

31
Q

size and weight of ovaries

A

3-6g during reproductive years and are the size of almonds

32
Q

when ovarian cancer is found in premenopausal women what is the main pathology

A

germ cell tumours

33
Q

protective factors from ovarian cancer

A 
multiple cholren (multiparty)
vitamin D sunlight (lower incidences in countries with warmer climates)
oral contraceptives (especially in nullparious women)
34
Q

diseases that can indicate ovarian cancer

A

nonpolyposis colorectal cancer, family history of ovarian, endometrial , lynch syndrome, Peutz-Jeghers syndromeBRCA 1 and BRCA2

35
Q

what is latzko’s tried

A

pelvic pain, pelvic mass and serosanguinous vaginal discharge - s&s of ovarian cancer

36
Q

Transvaginal US

A

used in the diagnosis of ovarian cancer it is more sensitive, especially when used with the colour flow doppler

37
Q

the use of CT in the diagnosis of ovarian cancer

A

used to detect upper abdominal and retroperitoneal disease

38
Q

surgical staging procedure

A

patients require surgery for staging. after staging a TAHBSO should be performed with a appendectomy as there is a high frequency of metastatic involvement. Patients who do not get complete surgical staging should have a second look laparotomy

39
Q

what type of tumour markers can be used with ovarian cancer when are they used?

A

CA-125 is used for serous adenocarcinoma while CA-19-9 is best used with mutinous tumours

40
Q

upper limit of ca-125 levels

A

> 35units/ml

41
Q

most useful use of ca-125 in ovarian cancer

A

ca-125 is most useful in determining if there is disease recurrence or progression

42
Q

what is considered low risk ovarian cancer

A

stage 1 grade1

43
Q

what is considered to be mid risk ovarian cancer

A

Grade 1 (stage 2-4), grade 2 (stage 1-2) grade 3 (stage 1 and stage 2 with no post op residual disease)

44
Q

what is considered to be high risk ovarian cancer

A

grade 2 (stage 3 and 4) grade 3 (stage 2 with residual disease, stage 3 and 4)

45
Q

types of cytoreductive surgeries (debunking)

A
  • primary cytoreductive surgery is done before adjuvant tx
  • interventional cytoreduction surgery is done after a few rounds of chemo for pts who couldn’t do primary surgery
  • secondary cytoreduction- performed after all chemotherapy is done
46
Q

energy of Phosphorus 32, depth and use in ovarian cancer

A

energy is .69Mev, depth = 1.5-3mm is used for patients with minimal or no residual disease after XRT

47
Q

WHEN is chemo used timing of treatment ? what agents are used and how many cycles?

A

surgery is given and then chemo

cisplatinum and cyclophosphamide +paclitaxel are given for 6 cycles

48
Q

use of hormonal therapy in ovarian cancer, what hormones are used

A

can be used for recurrent cancer after maximal chemo is given therapies can be anti androgens, anti estrogens, antigonadalprotein

49
Q

treatment of dysgerminomas

A

these are germ cell ovarian tumours that occur in younger patients 20-30’s .
they are germ cell tumours and are rare -3% of ovarian ca
early stages still get TAHBSO
they are radiosensitive tumours and are treated with 25-30Gy
recurrences and high stage disease are treated with chemo

50
Q

when and how should P32 be administered in the treatment of ovarian cancer?

A

15-20mCi of P32 should be given intraperitoneally for its with post op microscopic disease.
it should be administered within 12hours after Sx. through 2 intraperitoneal catheters placed during laparotomy

51
Q

what must be included when treating ovarian cancerXRT

A

the entire retroperitoneal cavity

52
Q

blocks used to shield OARS in xrt

A

1 HVL ant an liver block should be used so rt liver hemidiaphragm received <25Gy
post 5HVL kidney block should be used to limit kidney dose to 18Gy

53
Q

what serum marker level is looked at in diagnosis

what levels would be seen?

A

Ca-125

levels in postmenopausal women would be >65U/ml

54
Q

most common pathology

A

epithelial

55
Q

what stage is ovarian cancer most commonly diagnosed at

A

III C

56
Q

What LN Are most commonly involved

A

pelvic and par aortic

57
Q

most common distant mets site

A

liver

58
Q

what causes ascites

A

tumour cells can obstruct the lymph nodes causing the ascites

59
Q

what treatment type is not typically used in treating ovarian cancer?
why?

A

radiation therapy

it isnt used very much because chemotherapy has less severe sided effects and chemo has better tumour control

60
Q

most important prognosticc indicator for ovarian cancer

A

tumour stage

61
Q

what Ca-125 level is a positive prognostic indicator?

At what point?

A

Ca-125 level of <10U/ml is a positive prognostic indicator after treatment

Skin Radiation therapy (40 decks)

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