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Gynae > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

1
Q

Ovarian cancer Ix

A 
TVUSS
Tumour markers (CA125)
RMI
CT+/-MRI
Aspiration of ascites
USS/CT needle biopsy
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2
Q

What does TVUSS tell you about ovarian cancers?

A 
Size
Consistency
Solid elements?
Bilaterality
Ascites?
Extraovarian Dx (peritoneal/omental deposits)
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3
Q

Raised CA125?

A

(80% of epithelial) Ovarian cancers
Pregnancy
Endometriosis
Alcoholic liver dx

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4
Q

RMI

A 
Risk of malignant index
Calculated from:
- menopausal status
- pelvic USS
- CA125
>250 high, <25 low
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5
Q

CT/MRI in Ovarian cancer

A

Indicated in any suspicious pelvic pathology
CT good for staging
MRI determines operability

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6
Q

Surgical Mx of Ovarian Cancer

A 
Stage Dx and remove all visible tumour
TAH+BSO + omentectomy
Ascites/peritoneal washings sampled
?Further debulking (bowel, peritoneal stripping)
LN rescetion important
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7
Q

Most important prognostic factor in ovarian cancer

A

No residual disease following laparotomy

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8
Q

If unsuitable for ovarian cancer surgery

A

Chemotherapy w/second look laparotomy to see extent of residual disease

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9
Q

Summary of Mx of ovarian cancer

A

Surgery w/Pt based chemo

Aim: <1cm residual macroscopic tissue

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10
Q

Ovarian tumour deposits amenable to resection?

A

Bowel, spleen, peritoneum

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11
Q

Ovarian tumour deposits not amenable to resection?

A

porta hepatis, bowel mesentary

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12
Q

Supraradical ovarian cancer surgery

A

BSO+TAH+omentectomy and lympheadenectomy + removal of all visible disease
indicated in prev. fit women w/disseminated dx if complete cytoreduction possible
a/w perioperative mort/morb.

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13
Q

Alternative to supraradical surgery

A

3 cycles of neoadjuvant chemo followed by debulking is not inferioir and a/w less morbidity

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14
Q

Chemotherapy in ovarian cancer

A

Can be primary treatment, adjunct or for relapse
1st line: Pt agent w/paclitaxel
OP 3wks apart 6 cycles

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15
Q

Platinum compounds in ovarian cancer

A 
Most effective 
Cross linkage of DNA strands
Carboplatin main compound
(less nephrotox. and nausea and cisplatin)
Dose of carboplatin calculated using GFR
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16
Q

Paclitaxel

A

Ovarian cancer
Microtubular damage prevents cell replicaton
Preemptive steroids for SE (peripheral neuropathy, neutropenia, myalgia)
Total loss of body hair

17
Q

Bevacizumab

A

Ovarian cancer
mAb anti-VEGF
expensive
Mx of recurrent disease

18
Q

Follow up after ovarian chemo

A

CT to assess response

CA125

19
Q

Prognosis in ovarian cancer

A

5 year survival: 46%, stage 1 90%, stage 3 30%

20
Q

PACES Counselling of ovarian cancer

A

RF: age, FHx, obesity, HRT, endometriosis, smoking, DM
Protective factors: COCP, pregnancy, breastfeeding, hysterectomy
Dx: cancer of the ovaries
Ix: scans, bloods
Mx: chemo +/- surg

21
Q

Sex cord stromal tumour

A

granulosa and thecal cells

22
Q

Sex cord stromal tumour Mx

A

Based on age, wish to preserve fertility

  • Young: unilateral salpingoophectomy, endometrial sampking sufficient
  • Old: full surgical staging

No effective chemotherapy

23
Q

Which sex cord stromal tumour recurrs?

A

Granulosa cells so require long term FU

24
Q

Germ cell tumour

A

Seminoma
Dysgerminoma
Embryonic

25
Q

Germ cell tumour Mx

A

Fertility sparing bc most are reproductive age
Exploratory laparotomy to remove tumour and access contralateral ovary
Inspection of abdominal cavity required for peritonral biopsy and sampling of enlarged pelvic/para-aortic nodes
Post op chemo

26
Q

Post operative chemotherapy in Germ cell tumour

A

Depends on stage:
common: bleomycin, etoposide, cisplatin
3-4 treatmens 3 weeks apart
90% cure

27
Q

Figo Ovarian

A

I: limited to ovary
II: tubes or uterus
III: local LN and peritoneum
IV: distant exc. peritoneal; pleural effusion w/cytology, non retro peritoneal LN

Gynae (20 decks)

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