Ovarian cancer (full lecture)

Question 1

T/F: Ovarian cancer is less common than endometrial cancer but more fatal.

Answer 1

True.

It is fatal because 60% have metastatic disease at presentation!!

Question 2

What is the mainstay of treatment for ovarian cancer?

Answer 2

surgery + chemo (before, after or both)

Question 3

T/F: progress has been made in the cure rate for ovarian cancer over the last 30 years.

Answer 3

False. Very little progress (different from other cancers)

Question 4

How is ovarian cancer staged?

Answer 4

surgically

Question 5

How does ovarian cancer spread?

Answer 5

• intraperitoneally.

- doesn’t spread through blood or lymph very often.

Question 6

most common type of ovarian cancer

Answer 6

EOC - epithelial ovarian cancer - 80% - serous variety is the most common (out of 6 types)

followed by germ cell, and then sex cord stromal

Question 7

median age of presentation for ovarian cancer.

Answer 7

65 yo

Question 8

T/F - All types of ovarian cancer tend to occur in old age (past 6th decade)

Answer 8

FALSE.

-Germ cell tumors, and sex cord stromal tumors, the second and third most common tumors, are both tumors of young women.

Question 9

T/F - the three types of ovarian cancer all have relatively equal mortality.

Answer 9

false. Germ cell tumor has significantly better prognosis.

Question 10

Presentation of sex cord-stromal ovarian tumors

Answer 10

EXCESS ESTROGEN

• precocious puberty
• vaginal bleeding (postmenopausal women)
• adenomatous hyperplasia

Question 11

2 most important (major) Risk factors for epithelial ovarian cancer.

Answer 11

Family history & age

Question 12

4 minor risk factors for ovarian cancer

Answer 12

• nulliparity
• late childbirth
• endometriosis
• early menarche, late menopause
• Think; high estrogen + endometriosis

Question 13

3 manners of risk reduction for ovarian cancer

Answer 13

• OCP - oral contraception - reduce risk of endometrial AND ovarian cancer!!
• breastfeeding
• tubal ligation

Question 14

common presenting symptoms of ovarian caancer

Answer 14

Overall, non-specific and vague (hard to recognize - hence late stage presentation!!)

• abdominal bloating (clothes don’t fit)
• fatigue
• abdominal pain, back pain, pain with sex
• early satiety
• indigestion
• constipation
• urinary frequency/incontinence

Question 15

T/F - Hereditary syndromes make up nearly half of all Epithelial ovarian cancer (EOC)

Answer 15

False - they only account for about 10%

• BRCA
• HNPCC
• Lynch 2

Question 16

3 family syndromes which cause epithelial ovarian cancer

Answer 16

• BRCA
• HNPCC
• Lynch 2

-also cause colorectal, breast, endometrial, and others - ask about family history of these cancers, not just ovarian cancer!!

Question 17

lifetime risk of ovary cancer with familial syndromes

Answer 17

• BRCA1 - 40%, BRCA2 = 20%

- HNPCC - 10-15% (much smaller than colon/endometrial cancer risk)

Question 18

You are screening for ovarian cancer with transvaginal ultrasound. What characteristics indicate a malignancy vs. a benign mass?

Answer 18

Indicate malignancy

• solid or solid/cystic combo
• multiple septations
• bilateral masses
• strong blood flow
• irregular borders

these all indicate malignancy!!

Question 19

T/F CA125 is a sensitive but non-specific test for ovarian cancer

Answer 19

FALSE. neither.

Question 20

CA125 - features as a screening test.

Answer 20

• very non specific test, (elevated in any case of malignancy / inflammation in the abdomen.)
• normal value in 50% of stage 1 tumors
• better in post-menopausal pt’s

Question 21

T/F - ovarian screening with CA125 and TVUS is recommended in pt’s over 60

Answer 21

FALSE. screening can cause harm in asymptomatic women (false positive –> unnecessary surgeries)

-If patients have high risk for ovarian cancer, screening can be useful

Question 22

5 conditions which, if found in a POST-menopausal woman, along with pelvic mass, should prompt referral to a high volume ovarian cancer center. (important!!)

Answer 22

• Elevated CA125 ( >35)
• ascites
• nodular or fixed pelvic mass
• evidence of distant metastasis
• family history of breast or ovarian cancer.

Question 23

4 conditions which, if found in a PRE-menopausal woman, along with pelvic mass, should prompt referral to a high volume ovarian cancer center. (important!!)

Answer 23

• -Elevated CA125 ( >200)
• ascites
• evidence of distant metastasis
• family history of breast or ovarian cancer.