Ovarian cancer

Question 1

what is the peak age of incidence of ovarian cancer

Answer 1

75, diagnosed much later than other gynae cancers

Question 2

are there any precursor lesions for ovarian cancer

Answer 2

no

Question 3

what is the main risk factor for ovarian cancer (simple terms)

Answer 3

the number of times the woman ovulates

Question 4

what is the aetiology of ovarian cancer

Answer 4

genetic predisposition - lynch syndrome, BRCA1 and 2 mutations
endometriosis may increase risk
parity, breast feeding and COCP are all protective as reduces number of times ovulating

Question 5

how are epithelial ovarian tumours categorised

Answer 5

benign, borderline and malignant

Question 6

what are the types of ovarian tumours deriving from the epithelium

Answer 6

serous
mucinous
endometrioid 
cell cell
Brenner

Question 7

what is the most common type of epithelial tumour

Answer 7

serous - overall most common ovarian tumour

Question 8

are serous tumours benign or malignant

Answer 8

always malignant, grouped into low grade or high grade

Question 9

describe mucinous tumours

Answer 9

often benign but can turn malignant, malignant usually affects both ovaries
contain mucinous fluid

Question 10

describe endometrioid tumours

Answer 10

malignant but present at an early stage
histologically the same as endometrial cancer, 30% will have an existing endometrial cancer
associated with lynch syndrome

Question 11

what are the types of sex cord/stromal tumours that can occur in the ovary

Answer 11

granulosa cell
thecoma
sertoli/leydig cells

Question 12

describe granulosa cell tumours

Answer 12

low grade but malignant potential
secrete sex hormones and can cause abnormal menstrual bleeding
histologically cells have coffee bean nuclei

Question 13

are thecomas benign or malignant

Answer 13

usually benign

Question 14

what is Meigs syndrome and with what ovarian tumour does it occur

Answer 14

occurs with thecoma, paired with ascites and pleural effusion
resolves once tumour is removed

Question 15

describe sertoli tumours

Answer 15

rarest, slow growing and usually benign
usually occurs in women under 20
usually non-functional but can be androgenic

Question 16

list the types of germ cell tumours and state the % of ovarian neoplasms they make up

Answer 16

20-25%
teratoma 
dysgerminoma 
yolk sac tumour 
choriocarcinoma

Question 17

describe teratomas

Answer 17

most common germ cell tumour
usually benign and contains elements from all 3 germ layers
mature teratomas contain hair and teeth, immature contain embryonic tissue

Question 18

describe dysgerminomas

Answer 18

most common malignant germ cell tumour
associated with gondoblastoma
hCG level may be increased

Question 19

describe yolk sac tumours

Answer 19

hCG normal but AFP is increased
highly malignant but rare
occur in children and young women

Question 20

describe choriocarcinoma

Answer 20

highly malignant, tumour secretes hCG so may have precocious puberty
poor prognosis and does not respond to chemotherapy

Question 21

what are the likely locations of malignant tumours of the ovary to metastasise to

Answer 21

endometrium
breast
pancreas
GI tract

Question 22

what are the symptoms of ovarian cancer

Answer 22

early cancer can be asymptomatic 
feeling of bloating
early satiety 
bowel obstruction 
abdo distension due to ascites or pelvic mass

Question 23

a post menopausal woman presents with bloating and early satiety, what marker should be tested

Answer 23

CA125

Question 24

is CA125 a diagnostic indicator for ovarian cancer

Answer 24

no as it is not specific to ovarian cancer, it is raised in many other cancers. better to rule in/out the condition and as a marker of disease progression

Question 25

when is CEA (carinoembryonic antigen) marker useful

Answer 25

to assess how effective treatment for ovarian or colorectal cancer is
also excludes secondary GI mets