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Week 31 (Ovarian masses) > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

1
Q

Mortality rate

A

Leading cause of gynae death
1000 diagnosed per year
900 women die per year

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2
Q

Lifetime incidence

A

1.7%

Majority not hereditary (10-15% are)

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3
Q

5 year survival rates by stage

A

I: 90%
II:80%
III: 15-50%
IV: 5-15%

**most patients diagnosed at stage III

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4
Q

Epithelial type cancers

A

75% of all ovarian cancers are epithelial

Serous:45%
Mutinous:25%
Endometriod:15%
Clear cell: 10%
Transitional
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5
Q

Germ cell type

A

15-20%

Dysgerminoma
Yolk sac tumour
Choriocarcinoma
Immature teratoma

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6
Q

Sex-cord stromal types

A

5%

Granulosa
Thecoma
Fibroma
Sertoli-leydig

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7
Q

Risk factors for ovarian cancer

A 
Age
Early age menarche
Late age menopause
Infertility
Nulliparity
Late childbirth (age>35)
Caucasian race
Endometriosis
Heridarty syndromes
BRAC1 40%
BRAC2 15-20%
HNPCC 10-15%
Fam hx 5% if one first degree relative; 7% if two
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8
Q

Pathophysiology of ovarian cancer

A

Fallopian tube as site of origin
Transfer of normal and abnormal tubal epithelium to ovary
After ovulation, tubal cells implant on denuded ovarian surface

? Only in BRAC+

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9
Q

Ca 125 - value of

A

Elevated in 80% of stage III disease
Poor sensitivity (only elevated in 50% of women with stage 1)
Specificity problematic
-elevated in ~1% healthy woman
-may fluctuate during menses
- associated with common, benign conditions (endo, fibroids, PID, adenomyosis, pregnancy)

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10
Q

Forms of risk reduction

A

OCPs (30-60% RR, increased w duration of use) - BRCA gene women offer
BFing
Tubal ligation
BSO :opportunistic salpingectomy, role in BRCA gene fault carriers and Lynch syndrome; reduces risk of breast cancer in BRCA gene fault carriers

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11
Q

Differential diagnosis of pelvic mass

A 
Benign: 
Functional cyst
Leiomyomata
Endometritis
TOA
Ectopic
Teratoma
Cystadenoma

Borderline

Malignant
Epithelial
Germ cell
Sex-cord stromal

Non gynae: diverticula disease, pelvic kidney, colon ca breast ca, gastric ca

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12
Q

Tumor markers for epithelial

A

Ca-125
CEA
Ca 19-9
He4

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13
Q

Germ cell tumor markers

A

LDH
AFP
B-hcg
Inhibin

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14
Q

Sex cord stromal tumor markers

A

E2
FSH
Inhibin
Testosterone

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15
Q

Spread patter on epithelial

A

Symptoms 3-6 months
Local extension
Transpertoneal (upper/lower abdo)
Lymphatic spread

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16
Q

Treatment choices by grade and stage

A

Observe: stage IA/B, grade 1-2
Chemo: Stage IA/B, grade 3; Stage IC any grade and Stage II

17
Q

Procedures to achieve cytoreduction for advanced disease

A 
TAH/BSO
One texting
Peritoneal implant resection
Resection of rectosigmoid
Small bowel resection
Diaphragmatic stripping
Splenectomy, hepatectomy, distal pancreatectomy, urologic, abdominal wall
Lymphadenectomy

Then Chemo
If not surgical candidate - straight to chemo for 3-4 cycles then consider cytoreduction, then complete chemo

18
Q

Not debulkable

A

Bulky upper abdominal disease
Large volume ascites with extensive serosal disease
Extra-abdominal disease or intra-hepatic mets

19
Q

Low grade serous ovarian carcinoma

A

Younger women
Better prognosis
Chemo-resistant

20
Q

RMI >200 spec and send

A

97% and 87%

More useful postmenopausal

21
Q

Invx

A 
routine bloods incl clotting profile
Ca125, CEA
CXR - if ascites or need pleural tap
CT and USS
Colonoscopy, gastroscope if indicated
22
Q

Stage 1

A

Limited to ovary
A: 1 ovary
B: both ovaries
C: surface involvement, +ve washings

23
Q

Stage 2

A

Pelvic extension
A: aerosol uterine/tubal disease
b: other pelvic structures
C: with positive washings

24
Q

Stage 3

A

Outside pelvis
A: microscopic Mets
B: macroscopic Mets <2cm
C: >2cm/ nodal Mets

25
Q

Stage 4

A

Distant Mets

26
Q

Adequate staging

A 
Remove tumour
Omentum
Peritoneal washings
Peritoneal biopsies
Para aortic and pelvic lymph nodes

30% of stage 1 cases will be upstaged by an adequate staging procedure

27
Q

BRAC1 - lifetime risk

A

Risk of cancer 40% of cancer Fallopian tube/ovary by 70 years

(80% of hereditary ovarian cancers)

28
Q

BRAC2 risk

A

15-20% tube/ovary cancer by age 70

29
Q

Any endometrial cancer

A

Typically get mistmatch repair gene screening

30
Q

Lynch Syndrome cancer risk

A

Ovary 10-20%
Endometrial cancer 60%
Bowel 40%

31
Q

Pseudomyxoma

A

Primary appendiceal lesion - extrusion of epithelial cells from adenoma with redistribution phenomenon
Occasionallly ovary and other gi sites

Week 31 (Ovarian masses) (2 decks)

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