OVARIAN CANCER (SB) Flashcards
What is the second most common malignancy of the lower female genital tract?
Ovarian cancer.
What is the most frequent cause of death among gynecologic malignancies?
Ovarian cancer, due to late detection after metastatic spread.
What are the three most common gynecologic cancers in the US?
Endometrial, ovarian, cervical.
What are the three most common gynecologic cancers in the Philippines?
Cervical, ovarian, endometrial.
Why is ovarian cancer often detected late?
Because symptoms only appear after metastatic spread.
What is a major risk factor for endometrial cancer?
Anovulation.
What is a major risk factor for ovarian cancer?
Ovulation.
Why does regular ovulation increase the risk of ovarian cancer?
Because ovulation causes repeated injury to the ovary.
What reproductive history increases the risk of ovarian cancer?
Nulliparity (non-gravida).
What reproductive history increases the risk of endometrial cancer?
Gravida (pregnancy history).
At what age does the risk of ovarian cancer markedly increase?
Beyond 50 years, with a peak at 70 years.
What dietary factor increases the risk of ovarian cancer?
High animal fat diet (saturated fats).
What dietary factor may reduce the risk of ovarian cancer?
Vegetable fiber.
What type of cancer has the strongest familial link among gynecologic cancers?
Ovarian cancer.
How does industrialization relate to ovarian cancer risk?
Higher incidence in industrialized countries.
What fertility-related conditions increase the risk of ovarian cancer?
Infertility and ovulatory cycles.
What genetic mutation is associated with ovarian cancer?
Overexpression of mutant p53 protein.
What reproductive factors decrease the risk of ovarian cancer?
Breastfeeding, pregnancy, use of oral contraceptives (OCP), tubal ligation, hysterectomy with ovarian conservation.
How do oral contraceptive pills (OCPs) reduce ovarian cancer risk?
They suppress ovulation by providing external steroids that compete with endogenous estrogen and progesterone.
What is the typical clinical presentation of ovarian cancer?
Vague, non-specific symptoms that do not directly indicate ovarian origin.
Why is ovarian cancer difficult to diagnose early?
The ovaries are located retroperitoneally, making symptoms nonspecific and often leading to late diagnosis.
What are the common symptoms of ovarian cancer?
Increased abdominal size (ascites), bloating, urinary urgency, pelvic pain.
What is the most common type of ovarian cancer?
Epithelial stromal tumors (65%).
What is the second most common type of ovarian cancer, particularly in young women?
Germ cell tumors (20-25%).
What type of ovarian tumor contains elements of all three embryonic layers?
Germ cell tumors.
What type of ovarian tumor contains elements that mimic ovarian structures?
Sex cord-stromal tumors (6%).
What are lipid (lipoid) cell tumors, and how common are they?
Extremely rare ovarian tumors that histologically resemble the adrenal glands (<0.1%).
What are gonadoblastomas, and in whom do they occur?
Tumors containing germ cells and sex cord-stromal cells, occurring in individuals with dysgenetic gonads, especially those with a Y chromosome.
What are two examples of soft tissue tumors that can occur in the ovary?
Hemangioma (blood vessels) and lipoma (subcutaneous tissue).
What is an example of a highly virulent unclassified ovarian tumor?
Small cell carcinoma.
What is a Krukenberg tumor?
A metastatic tumor to the ovary originating from the stomach or bowel.
What are tumor-like conditions that cause ovarian enlargement but are not true neoplasms?
Extensive edema, endometrioma, pregnancy luteoma, follicular or luteal cyst.
What is the main cause of ovarian malignancy in young women?
Germ cell tumors.
Why do germ cell tumors commonly affect teenagers and young adults?
Because they originate from embryonic layers and are the most common ovarian malignancy in young women.
What is the role of sex cord-stromal tumors in hormone secretion?
Some secrete sex steroid hormones, while others are hormonally inactive.
Which ovarian tumor category includes the most frequent neoplasms?
Epithelial stromal tumors (common epithelial tumors).
What differentiates metastatic ovarian tumors from primary ovarian tumors?
Metastatic tumors originate from other sites, such as the reproductive tract, stomach, or bowel.
What is the most common type of epithelial ovarian tumor?
Serous epithelial ovarian tumor.
What type of epithelial ovarian tumor consists of ciliated epithelial cells resembling the fallopian tubes?
Serous epithelial ovarian tumor.
What is the benign form of serous ovarian tumors?
Serous cystadenomas.
In which age group do serous ovarian carcinomas typically occur?
Women older than 40 years.
What type of ovarian tumor consists of epithelial cells filled with mucin?
Mucinous epithelial ovarian tumor.
What two structures can mucinous ovarian tumors resemble?
Endocervix and intestinal cells.
What type of ovarian tumor resembles the endometrium and is associated with endometriosis?
Endometrioid ovarian tumor.
In what age group do endometrioid ovarian tumors usually occur?
Women in their 40s and 50s.
What type of ovarian tumor is associated with diethylstilbestrol (DES) exposure?
Clear cell ovarian tumor.
What cellular feature characterizes clear cell ovarian tumors?
Hobnail cells with nuclei protruding into the glandular lumen.
What ovarian tumor type resembles the transitional epithelium of the bladder?
Brenner (transitional) ovarian tumor.
What is the primary imaging modality for evaluating adnexal masses?
Ultrasound (IOTA - International Ovarian Tumor Analysis).
What ultrasound features help differentiate benign from malignant ovarian masses?
Simple (unilocular) vs. complex (multilocular with solid component), papillary projections, cystic wall/septa regularity, echogenicity, and color flow (neovascularization).
What is the role of Doppler color-enhanced flow studies in adnexal mass evaluation?
To differentiate benign from malignant masses based on blood flow patterns.
What tumor marker is used in ovarian cancer evaluation?
CA-125.
Is CA-125 specific for ovarian cancer?
No, it is not specific but is sensitive; it can be elevated in conditions like endometriosis, pregnancy, appendicitis, and infections.
What percentage of ovarian epithelial carcinomas express CA-125?
Approximately 80%.
What is the CA-125 level generally considered increased?
> 35 U/mL.
Besides ovarian cancer, what cancers can elevate CA-125?
Primary peritoneal, fallopian tube, uterine, colon, breast, stomach, and liver cancers.
What non-cancerous conditions can elevate CA-125?
Leiomyomata, endometriosis, pelvic infection, liver/heart/kidney failure, peritonitis, pancreatitis, pregnancy, and mild menstrual cycle changes.
What is the normal size of an ovary?
1.5 x 2.5 x 4 cm.
What is the approximate size of a normal postmenopausal ovary?
1.5 to 2 cm in diameter.
At what ovarian size in postmenopausal women is surgery indicated?
> 3 cm.
What ovarian size is considered abnormal in the reproductive age group?
> 5 cm.
What ultrasound features suggest a malignant ovarian mass?
Solid component, echogenic areas, septations, and color Doppler neovascularization.
What are the primary lymph node routes for ovarian cancer spread?
Pelvic and paraaortic lymph nodes.
What are the most frequent sites of ovarian cancer relapse?
Pelvic and aortic lymph nodes (39%), peritoneum (33%), bowel (28%), and pelvis (22%).
According to FIGO staging, what defines Stage 1A ovarian cancer?
Cancer is confined to one ovary with an intact capsule.
According to FIGO staging, what defines Stage 1B ovarian cancer?
Cancer is present in both ovaries with intact capsules.
According to FIGO staging, what defines Stage 1C ovarian cancer?
Cancer has ruptured the ovarian capsule.
What are the major prognostic factors for ovarian cancer?
Tumor stage, tumor grade, and residual tumor after primary resection.
How does tumor stage affect ovarian cancer prognosis?
Higher stage = poorer prognosis.
How does tumor grade affect ovarian cancer prognosis?
Poorer grade = poorer prognosis.
What is the major determinant of ovarian cancer prognosis?
Tumor grade.
What is the primary goal of cytoreductive surgery in advanced ovarian cancer?
Debulking the tumor.
What are the objectives of ovarian cancer surgery (hysterectomy - TAHBSO)?
Diagnosis, fertility preservation (if unilateral), surgical staging (early stage), and cytoreduction (advanced stage).
What is the standard chemotherapy regimen for ovarian cancer?
BEP [bleomycin, etoposide, cisplatin] regimen.
Which ovarian tumor type is highly radiosensitive?
Pure dysgerminoma.
