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OB/GYN > Ovarian & Fallopian tube tumors > Flashcards

Ovarian & Fallopian tube tumors Flashcards

1
Q

what are the diff places in the ovary that a tumor can arise from?

A

epith
stroma
germ cells
rarely, a met from other primary cancers

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2
Q

what is the most common origin of an ovarian cancer?

A

epithelium

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3
Q

what is a Krukenberg tumor?

A

a met to the ovary (primary is usually GI, breast, or endometrium)

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4
Q

how is ovarian c. spread?

A

direct exfoliation of cells through peritoneal fluid, lymph spread. Hematogenous is more rare.

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5
Q

CP of advanced ov ca?

A 
vague ab'l pain
early satiety
pelvic P
urinary freq, dysuria
ascites (2/2 intraperitoneal tumors)
ventral hernia
ileus (2/2 bowel being encased with tumor)
=> malnutrition, cachexia
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6
Q

how does ovarian epith cancer arise?

A

prolonged periods of uninterrupted ovulation (nulliparity, delayed childbearing, late menopause) => disruption of epith => need to activate cellular repair mechs => more opportunities for mutations to arise

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7
Q

familiar ov cancer syndromes:

A 
Lynch II (HNPCC + ov + breast + endometrial)
BRCA2 >> BRCA1
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8
Q

what is the risk of dvp’ing ov ca in an ave-risk pt? (1 in what)

A

1 in 60

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9
Q

median age of dx of ov ca?

A

61

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10
Q

what should you think of in a pt under age 20 with an ovarian tumor?

A

germ cell tumors (not epith)

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11
Q

what can protect against ov ca?

A

OCPs (less ovulatory events)
multiparity
breastfeeding
chronic anovulation

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12
Q

what is a Sister Mary Joseph nodule

A

ov ca mets to umbilicus

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13
Q

w/u of adnexal mass:

A

pelvic u/s
dtm if benign or malignant
may need CT or MRI
DO NOT do paracentesis or cyst aspiration! Can spread dis!
if malignant, need to decide if its ov primary or met from somewhere else.

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14
Q

u/s findings of a benign adnexal mass:

A 
< 8cm
cystic
not loculated
unilateral
calcifications, teeth, hair present
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15
Q

u/s findings of a malignant adnexal mass:

A 
> 8 cm
solid or cystic + solid
multilocular
bilateral
ascites
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16
Q

how is ov ca staged?

A

surgically - do TAHBSO, omentectomy, peritoneal washes, cytology, pap smear of diaphragm, sample pelvic & para-aortic LNs

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17
Q

char’ics of each stage:

A 
stage I = growth is limited to ovaries
stage II = dis extends from ovary to pelvis
stage III = dis extends into ab'l cavity
stage IV = distant mets 
(most are at stage III or IV)
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18
Q

what are the 6 types of ovarian epithelial tumors?

A 
serous
mucinous
endometrioid
clear cell
Brenner
undiff'd
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19
Q

what is the most common malig ov epith cell tumor?

A

serous cystadenocarcinomas

20
Q

where do ovarian epith tumors tend to extend?

A

peritoneum, not underlying ovary

21
Q

what is CA-125 used for?

A

tracking effect of tx & recurrence

22
Q

tx of ov ca?

A

TAHBSO, omentectomy, bilat pelvic & para-aortic LN sampling. Then chemo, then “second-look” laparoscopy.

23
Q

5-yr survival rate for epith cell ov ca?

A

20%

24
Q

what do germ cell tumors arise from?

A

totipotent germ cells (ccan diff’ate into yolk salk, placenta, fetus)

25
Q

what are the most common germ cell cancers?

A 
dysgerminomas (50%) 
immature teratomas (20%)
26
Q

what do dysgerminomas produce?

A

LDH

27
Q

what do embryonal sinus tumors produce?

A

AFP

28
Q

what do choriocarcinomas produce?

A

hCG

29
Q

which has better prognosis - epith ov tumors or germ cell tumors? Why?

A

germ cell, b/c they are caught at early stages.

30
Q

are most germ cell tumors benign or malignant?

A

benign

31
Q

of germ cell tumors that are malignant, what age group do they tend to occur in?

A

women younger than 20

32
Q

how fast do germ cell tumors grow?

A

very rapidly

33
Q

CP of germ cell tumors

A

pelvic pain
urinary urgency
bowel urgency or constipation
elevations in LDH, hCG, AFP depending on cell type

34
Q

tx of germ cell tumors?

A

unilat SO, r/o cancer with surgical staging.
if cancer, do chemo
radiation only if its an advanced dysgerminoma (other types don’t respond to it)

35
Q

what is a sex cord-stromal tumor?

A

a low-grade malignancy that arises from the sex cord (before diff’ation into male or female) or from ov stroma

36
Q

What are the two types of sex cord-stromal tumor? Which is more common?

A

granulosa-theca cell tumors (more common)

Sertoli-Leydig cell tumors

37
Q

what hrms are sec’d by sex cord-stromal tumors?

A

granulosa-theca cell tumors sec ES & inhibin

Sertoli-Leydig cell tumors sec TS

38
Q

what is Meigs’ syndrome?

A

ov fibroid (non-fct’l tumor)
ascites
R hydrothorax

39
Q

what age group do sex cord-stromal tumors tend to occur in?

A

40-70

40
Q

CP of granulosa-theca cell tumors

A 
feminization
precocious puberty
menstrual irregularities
secondary amenorrhea
postmenopausal bleeding
endometrial hyperplasia or cancer
41
Q

CP of sertoli-Leydig cell tumors:

A 
breast atrophy
hirsutism
deepened voice
acne
clitoromegaly
receding hairline
oligo or amenorrhea
42
Q

tx of sex cord-stromal tumors?

A

unilat SO. TAHBSO if done with childbearing.

NO chemo or radiation

43
Q

most fallopian tube cancers are what kind?

A

adenocarcinoma, arise from tube mucosa

44
Q

cp of fallopian tube cancer:

A

usually asx’c, incidental finding

maybe vague lower ab’l pain

45
Q

what is hydrops tubae profluens

A

pathognomonic for fallopian tube cancer, but rarely seen. intermittent hydrosalpinx - profuse watery discharge, pelvic pain, pelvic mass

46
Q

tx of fallopian tube cancer:

A

same as ov cancer (TAHBSO, omentectomy, peritoneal cytologic studies, retroperitoneal LN sampling)
Chem + rad

OB/GYN (29 decks)

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