Ovarian & Fallopian tube tumors Flashcards
what are the diff places in the ovary that a tumor can arise from?
epith
stroma
germ cells
rarely, a met from other primary cancers
what is the most common origin of an ovarian cancer?
epithelium
what is a Krukenberg tumor?
a met to the ovary (primary is usually GI, breast, or endometrium)
how is ovarian c. spread?
direct exfoliation of cells through peritoneal fluid, lymph spread. Hematogenous is more rare.
CP of advanced ov ca?
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
how does ovarian epith cancer arise?
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
familiar ov cancer syndromes:
Lynch II (HNPCC + ov + breast + endometrial) BRCA2 >> BRCA1
what is the risk of dvp’ing ov ca in an ave-risk pt? (1 in what)
1 in 60
median age of dx of ov ca?
61
what should you think of in a pt under age 20 with an ovarian tumor?
germ cell tumors (not epith)
what can protect against ov ca?
OCPs (less ovulatory events)
multiparity
breastfeeding
chronic anovulation
what is a Sister Mary Joseph nodule
ov ca mets to umbilicus
w/u of adnexal mass:
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.
u/s findings of a benign adnexal mass:
< 8cm cystic not loculated unilateral calcifications, teeth, hair present
u/s findings of a malignant adnexal mass:
> 8 cm solid or cystic + solid multilocular bilateral ascites
how is ov ca staged?
surgically - do TAHBSO, omentectomy, peritoneal washes, cytology, pap smear of diaphragm, sample pelvic & para-aortic LNs
char’ics of each stage:
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)
what are the 6 types of ovarian epithelial tumors?
serous mucinous endometrioid clear cell Brenner undiff'd
what is the most common malig ov epith cell tumor?
serous cystadenocarcinomas
where do ovarian epith tumors tend to extend?
peritoneum, not underlying ovary
what is CA-125 used for?
tracking effect of tx & recurrence
tx of ov ca?
TAHBSO, omentectomy, bilat pelvic & para-aortic LN sampling. Then chemo, then “second-look” laparoscopy.
5-yr survival rate for epith cell ov ca?
20%
what do germ cell tumors arise from?
totipotent germ cells (ccan diff’ate into yolk salk, placenta, fetus)
what are the most common germ cell cancers?
dysgerminomas (50%) immature teratomas (20%)
what do dysgerminomas produce?
LDH
what do embryonal sinus tumors produce?
AFP
what do choriocarcinomas produce?
hCG
which has better prognosis - epith ov tumors or germ cell tumors? Why?
germ cell, b/c they are caught at early stages.
are most germ cell tumors benign or malignant?
benign
of germ cell tumors that are malignant, what age group do they tend to occur in?
women younger than 20
how fast do germ cell tumors grow?
very rapidly
CP of germ cell tumors
pelvic pain
urinary urgency
bowel urgency or constipation
elevations in LDH, hCG, AFP depending on cell type
tx of germ cell tumors?
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)
what is a sex cord-stromal tumor?
a low-grade malignancy that arises from the sex cord (before diff’ation into male or female) or from ov stroma
What are the two types of sex cord-stromal tumor? Which is more common?
granulosa-theca cell tumors (more common)
Sertoli-Leydig cell tumors
what hrms are sec’d by sex cord-stromal tumors?
granulosa-theca cell tumors sec ES & inhibin
Sertoli-Leydig cell tumors sec TS
what is Meigs’ syndrome?
ov fibroid (non-fct’l tumor)
ascites
R hydrothorax
what age group do sex cord-stromal tumors tend to occur in?
40-70
CP of granulosa-theca cell tumors
feminization precocious puberty menstrual irregularities secondary amenorrhea postmenopausal bleeding endometrial hyperplasia or cancer
CP of sertoli-Leydig cell tumors:
breast atrophy hirsutism deepened voice acne clitoromegaly receding hairline oligo or amenorrhea
tx of sex cord-stromal tumors?
unilat SO. TAHBSO if done with childbearing.
NO chemo or radiation
most fallopian tube cancers are what kind?
adenocarcinoma, arise from tube mucosa
cp of fallopian tube cancer:
usually asx’c, incidental finding
maybe vague lower ab’l pain
what is hydrops tubae profluens
pathognomonic for fallopian tube cancer, but rarely seen. intermittent hydrosalpinx - profuse watery discharge, pelvic pain, pelvic mass
tx of fallopian tube cancer:
same as ov cancer (TAHBSO, omentectomy, peritoneal cytologic studies, retroperitoneal LN sampling)
Chem + rad
