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MRCOG part 2 > Ovarian Masses > Flashcards

Ovarian Masses Flashcards

1
Q

Ovarian cancer is ___ most common cancer in women

A

6th

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2
Q

Cases of ovarian Ca with genetic predisposition

A

10-15%

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3
Q

Lifetime risk of ovarian Ca in general population

A

1 in 50

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4
Q

Risk of ovarian cancer with BRCA 1

A

1 in 2

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5
Q

Risk of ovarian cancer BRCA2

A

1 in 5

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6
Q

Risk of ovarian cancer HNPCC

A

1 in 10

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7
Q

Peak age incidence of ovarian cancer

A

60s

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8
Q

Ovarian cancer staging

A

Stage I - confined to ovary

Stage II - involves 1/both ovaries with pelvic extension OR primary peritoneal cancer

Stage III - involves 1/both ovaries with spread to peritoneum outside of pelvic OR metastasis to retroperitoneal lymph nodes

Stage IV - distant metastasis excluding peritoneal metastasis

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9
Q

Ovarian cancer stage 1A

A

Limited to 1 ovary with intact capsule
No tumour in surface
Negative washings

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10
Q

Ovarian cancer stage 1B

A

Same as 1A but involves both ovaries

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11
Q

Ovarian cancer stage 1C1

A

Limited to one or both ovaries but surgical spill

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12
Q

Ovarian cancer stage 1C2

A

Capsule ruptured before surgery or tumour on ovary surface

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13
Q

Stage 1C3 ovarian cancer

A

Malignant cells in ascites or peritoneal washings

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14
Q

Lifetime risk of ovarian cancer with affected 1st degree relative

A

5%

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15
Q

Ca125 positive in ___% ovarian cancers

A

80

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16
Q

Tumour markers for ovarian cancer

A

Ca125
HE4
Ca72.4
Ca19-9
CEA
AFP
HCG

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17
Q

Normal CEA levels in smokers

A

<5

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18
Q

Best combination of tumour markers in ovarian cancer

A

Ca125 + HE4

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19
Q

Ovarian cancer stage IIA

A

Extension or implant on uterus OR fallopian tube

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20
Q

Ovarian cancer stage IIB

A

Extension to other pelvic peritoneal tissues

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21
Q

Ovarian cancer stage IIIA

A

Positive retroperitoneal lymph nodes or microscopic metastasis beyond pelvis

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22
Q

Ovarian cancer stage IIIA1

A

Positive retroperitoneal lymph nodes only

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23
Q

Ovarian cancer stage IIIA1i

A

Mets <10mm

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24
Q

Ovarian cancer stage IIIA1ii

A

Mets >10mm

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25
Q

Ovarian cancer stage IIIA2

A

Microscopic extra pelvic peritoneal involvement + positive retroperitoneal lymph nodes

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26
Q

Ovarian ca stage IIIB

A

Macroscopic, extrapelvic peritoneal mets <2cm and positive retroperitoneal lymph nodes

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27
Q

Ovarian stage IIIC

A

Macroscopic extrapelvic peritoneal let’s >2cm + positive retroperitoneal lymph nodes
Includes extension to capsule of liver and spleen without parenchymal involvement

28
Q

Ovarian cancer stage IVA

A

Pleural effusion with positive cytology

29
Q

Ovarian cancer stage IVB

A

Hepatic or splenic parenchymal mets, mets to extra-abdominal organs or lymph nodes outside of abdominal cavity

30
Q

Proportion of women presenting with late stage ovarian cancer

A

70-75%

31
Q

Neoadjuvant chemo is for ___ cycles

A

3

32
Q

Ovarian cancer standard chemotherapy

A

Carboplatin + paclitaxel
6 cycles at 3 week intervals

33
Q

Targeted ovarian cancer treatments

A

Anti-VEGF
PARP inhibitors

34
Q

Adjuvant chemotherapy is not required for ________ ovarian cancer

A

Well differentiated tumours up to stage 1B

35
Q

Follow up after primary therapy of ovarian cancer

A

3-4 months for first 2 years
6 monthly up to 5 years

36
Q

Ca125 level in recurrence

A

Twice the upper limit of normal (70)

37
Q

Treatment of ovarian cancer recurrence

A

Platinum based agent if >1yr
Liposomal doxxorubicin if <1yr
Surgery for symptoms palliation
Paracentesis

38
Q

Treatment of poorly differentiated stage 1A/B or stage 1c - stage II ovarian cancer

A

Primary surgery
Adjuvant chemo 6 cycles

39
Q

Stage III and stage IV ovarian cancer treatment

A

Neoadjuvant chemo 3 cycles, interval debulking then 3 cycles chemo

40
Q

Chemotherapy in optimally reduced stage III/IV ovarian cancer

A

Intraperitoneal cisplatin/paclitaxel - improves survival but more side effects
IV chemo carboplatin/cisplatin + palclitaxel

41
Q

Treatment of suboptimally reduced ovarian cancer stage III/IV

A

Systemic carboplatin + paclitaxel (60% response with no recurrence in 1 year)
OR
Chemo + further surgery + chemo (no survival benefit

42
Q

Retroperitoneal lymph nodes are positive in ____ of stage 1 ovarian cancer

A

22%

43
Q

Optimal staging surgery for ovarian cancer is ___

A

midline laparotomy, TAH/BSO, washings, infracolic omentectomy
Random biopsies of pelvic and abdominal peritoneum
Retroperitoneal lymph node sampling (not block dissection)

44
Q

Classification of platinum sensitivity in recurrent ovarian cancer

A

Refractory - disease progression during chemo
Resistant - <6 months remission
Responsive - remission for >6 months

45
Q

5yr SR for ovarian cancer

A

Stage 1 - 94.5%
Stage 2 - 71.6%
Stage 3 - 31.9%
Stage 4 - 16%

46
Q

Ultrasound score criteria for RMI

A

Ascites
Bilateral cysts
Multilocular
Solid areas
Metastases

47
Q

Dysgerminoma proportion malignant vs benign

A

97% benign
3% malignant

48
Q

LDH is raised in

A

Dysgerminomas (94%)

49
Q

Dysgerminoma accounts for ___ ovarian malignancies and is bilateral in ____

A

1%
15%

50
Q

5yr SR for Dysgerminoma

A

95%

51
Q

Recurrence rate for Dysgerminoma

A

20%

52
Q

Chemotherapy agent for Dysgerminoma

A

Platinum based

53
Q

Abortion risk with surgery in 1st trimester of pregnancy

A

30%

54
Q

Timing of surgery for ovarian masses in pregnancy

A

16-18 weeks

55
Q

When should Surgery for dermoid cysts in pregnancy be done?

A

Second trimester
When cyst >6cm
If cysts bilateral

56
Q

Adjuvant chemotherapy for ovarian malignancy in pregnancy

A

Methotrexate and cisplatin

57
Q

5-hydroxyindoleactic acid (5-HIAA) is elevated in which ovarian masses?

A

Ovarian carcinoid tumours

58
Q

AFP is secreted by

A

Yolk sac tumours AKA endodermal sinus tumour

59
Q

Ovarian tumours that cause precocious puberty

A

Embryonal carcinoma
Polyembryoma
Granulosa cell tumour
Choriocarcinoma of the ovary

60
Q

Adnexal masses have a non-ovarian origin in ____ cases

A

10%

61
Q

Granulosa cell tumours produce

A

Oestrogen

62
Q

Granulosa cell tumours are associated with

A

Endometrial hyperplasia and cancer in 10%

63
Q

Inhibin B levels are raised in _____ cancers

A

Granulosa cell tumours

64
Q

Immature teratomas account for ___ germ cell tumours

A

20%

65
Q

Characteristics of immature teratomas

A

Unilateral
Arise from ectoderm, endoderm and mesoderm
Commonly contain neural tissue
Grade 1-3
No response to radiotherapy

66
Q

Brenner tumour origin

A

Wolffian remnants
Transitional epithelium

67
Q

Clear cell carcinoma origin

A

Müllerian ducts

MRCOG part 2 (22 decks)

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