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Reproduction Y3 > Ovarian cancer (zero to finals) > Flashcards

Ovarian cancer (zero to finals) Flashcards

1
Q

What is ovarian cancer?

A

Refers to cancer of the ovaries. Ovarian cancer often presents late due to the non-specific symptoms, resulting in a worse prognosis.

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2
Q

What is the most common type of ovarian cancer and how many subtypes does it have?

A

Epithelial cell tumours - which arise from the epithelial cells in the ovaries.

There are 5 different subtypes.

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3
Q

What are the 5 subtypes of epithelial ovarian cancer?

A

Serous

Mucinous

Endometrioid

Clear cell

Brenner (transitional cell tumours)

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4
Q

What are germ cell tumours/dermoid cysts?

A

They are teratomas, meaning they come from the germ cells.

They may contain various tissue types, such as skin, teeth, hair and bone.

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5
Q

Are germ cell tumours benign or malignant?

A

Benign ovarian tumours.

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6
Q

What are germ cell ovarian tumours associated with?

A

Ovarian torsion

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7
Q

What may be raised in germ cell ovarian tumours?

A

May cause raised alpha-fetoprotein (α-FP) and human chorionic gonadotrophin (hCG).

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8
Q

What are serous epithelial ovarian tumours?

A

Most common type of epithelial ovarian tumours.

They can be further classified as serous cystadenomas (benign), serous borderline tumors (low malignant potential), and serous carcinomas (malignant).

Serous carcinomas are the most aggressive type and can spread beyond the ovary to other organs.

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9
Q

What are mucinous epithelial ovarian tumours?

A

Characterised by the presence of mucin-producing cells.

They can be benign, borderline, or malignant.

Mucinous carcinomas are less common than serous carcinomas but can also spread to other organs if malignant.

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10
Q

What are endometrioid epithelial ovarian tumours?

A

Endometrioid tumours resemble the tissue of the uterine lining (endometrium).

They can be benign, borderline, or malignant.

Endometrioid carcinomas are often associated with endometriosis i.e. chocolate cysts.

May have a better prognosis compared to serous or mucinous carcinomas.

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11
Q

What are clear cell epithelial ovarian tumours?

A

Clear cell tumors have clear or pale cytoplasm when viewed under a microscope.

They are less common than other types of epithelial ovarian tumors but tend to have a poorer prognosis, especially when malignant.

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12
Q

What are brenner (transitional cell) epithelial ovarian tumours?

A

Brenner tumours, also known as transitional cell tumours, resemble the transitional epithelium of the urinary tract.

They are usually benign but can be borderline or rarely malignant.

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13
Q

What are sex-cord stromal tumours?

A

These are rare tumours, that can be benign or malignant.

They arise from the stroma (connective tissue) or sex cords (embryonic structures associated with the follicles).

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14
Q

What are the 2 types of sex-cord stromal tumours?

A

There are several types, including Sertoli–Leydig cell tumours and granulosa cell tumours.

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15
Q

Ovarian tumours may be due to metastasis from a cancer elsewhere. True/false?

A

True

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16
Q

What is a krukenberg tumour?

A

A Krukenberg tumour refers to a metastasis in the ovary, usually from a gastrointestinal tract cancer, particularly the stomach.

17
Q

What is a characteristic feature of krukenburg tumours?

A

Krukenberg tumours have characteristic “signet-ring” cells on histology, which look like signet rings on under a microscopy.

18
Q

What are the risk factors for ovarian cancer?

A

Age (peaks age 60)

BRCA1 and BRCA2 genes (consider the family history)

Increased number of ovulations (from early menarche, less/no pregnancies and late menopause)

Obesity

Smoking

Recurrent use of clomifene

19
Q

What factors increase the number of ovulations?

A

Early-onset of periods (early menarche)

Late menopause

No pregnancies

20
Q

Having a lower number of lifetime ovulations increases ovarian cancer risk. True/false?

A

False

More ovulations = higher risk

21
Q

What are protective factors against ovarian cancer?

A

Factors that stop ovulation or reduce the number of lifetime ovulations, reduce the risk, these include:

Combined contraceptive pill

Breastfeeding

Pregnancy

22
Q

What symptoms may indicate ovarian cancer?

A

Abdominal bloating

Early satiety (feeling full after eating)

Loss of appetite

Pelvic pain

Urinary symptoms (frequency / urgency)

Weight loss

Abdominal or pelvic mass

Ascites

23
Q

What nerve may be affected by an ovarian mass?

A

Obturator nerve

An ovarian mass may press on the obturator nerve and cause referred hip or groin pain.

24
Q

What would warrant an urgent 2 week wait cancer referral?

A

If a physical examination reveals:

Ascites

Pelvic mass (unless clearly due to fibroids)

Abdominal mass

25
Q

What is the risk of malignancy index (RMI)?

A

Estimates the risk of an ovarian mass being malignant.

26
Q

What are the 3 components of the risk of malignancy index for ovarian cancer?

A

CA-125 levels

Menopausal status

Ultrasound

27
Q

What further investigations can be carried out in secondary care for ovarian cancer?

A

CT scan to establish the diagnosis and stage the cancer

Histology (tissue sample) using a CT guided biopsy, laparoscopy or laparotomy

Paracentesis (ascitic tap) can be used to test the ascitic fluid for cancer cells

28
Q

Women under 40 years with a complex ovarian mass require tumour markers for a possible germ cell tumour, what tumour markers are assessed?

A

Alpha-fetoprotein (α-FP)

Human chorionic gonadotropin (HCG)

29
Q

CA125 is a tumour marker for epithelial cell ovarian cancer and is highly specific. True/false?

A

False

CA125 is a tumour marker for epithelial cell ovarian cancer however it is not very specific.

Many other things can cause an elevated CA125.

30
Q

What are the causes of raised CA125?

A

Endometriosis
Fibroids
Adenomyosis
Pelvic infection
Liver disease
Pregnancy

31
Q

What is stage 1 of the FIGO classification for ovarian cancer?

A

Confined to the ovary

32
Q

What is stage 2 of the FIGO classification for ovarian cancer?

A

Spread past the ovary but inside the pelvis

33
Q

What is stage 3 of the FIGO classification for ovarian cancer?

A

Spread past the pelvis but inside the abdomen

34
Q

What is stage 4 of the FIGO classification for ovarian cancer?

A

Spread outside the abdomen (distant metastasis)

35
Q

What is the management of ovarian cancer?

A

Ovarian cancer will be managed by a specialist gynaecology oncology MDT.

It usually involves a combination of surgery and chemotherapy.

36
Q

What is a major symptom that would indicate endometrial cancer instead of ovarian cancer?

A

Post-menopausal bleeding

Post-menopausal = after 12 consecutive months without experiencing a period.

Reproduction Y3 (78 decks)

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