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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
Ovarian cancer stage IIIA2
Microscopic extra pelvic peritoneal involvement + positive retroperitoneal lymph nodes
26
Ovarian ca stage IIIB
Macroscopic, extrapelvic peritoneal mets <2cm and positive retroperitoneal lymph nodes
27
Ovarian stage IIIC
Macroscopic extrapelvic peritoneal let’s >2cm + positive retroperitoneal lymph nodes Includes extension to capsule of liver and spleen without parenchymal involvement
28
Ovarian cancer stage IVA
Pleural effusion with positive cytology
29
Ovarian cancer stage IVB
Hepatic or splenic parenchymal mets, mets to extra-abdominal organs or lymph nodes outside of abdominal cavity
30
Proportion of women presenting with late stage ovarian cancer
70-75%
31
Neoadjuvant chemo is for ___ cycles
3
32
Ovarian cancer standard chemotherapy
Carboplatin + paclitaxel 6 cycles at 3 week intervals
33
Targeted ovarian cancer treatments
Anti-VEGF PARP inhibitors
34
Adjuvant chemotherapy is not required for ________ ovarian cancer
Well differentiated tumours up to stage 1B
35
Follow up after primary therapy of ovarian cancer
3-4 months for first 2 years 6 monthly up to 5 years
36
Ca125 level in recurrence
Twice the upper limit of normal (70)
37
Treatment of ovarian cancer recurrence
Platinum based agent if >1yr Liposomal doxxorubicin if <1yr Surgery for symptoms palliation Paracentesis
38
Treatment of poorly differentiated stage 1A/B or stage 1c - stage II ovarian cancer
Primary surgery Adjuvant chemo 6 cycles
39
Stage III and stage IV ovarian cancer treatment
Neoadjuvant chemo 3 cycles, interval debulking then 3 cycles chemo
40
Chemotherapy in optimally reduced stage III/IV ovarian cancer
Intraperitoneal cisplatin/paclitaxel - improves survival but more side effects IV chemo carboplatin/cisplatin + palclitaxel
41
Treatment of suboptimally reduced ovarian cancer stage III/IV
Systemic carboplatin + paclitaxel (60% response with no recurrence in 1 year) OR Chemo + further surgery + chemo (no survival benefit
42
Retroperitoneal lymph nodes are positive in ____ of stage 1 ovarian cancer
22%
43
Optimal staging surgery for ovarian cancer is ___
midline laparotomy, TAH/BSO, washings, infracolic omentectomy Random biopsies of pelvic and abdominal peritoneum Retroperitoneal lymph node sampling (not block dissection)
44
Classification of platinum sensitivity in recurrent ovarian cancer
Refractory - disease progression during chemo Resistant - <6 months remission Responsive - remission for >6 months
45
5yr SR for ovarian cancer
Stage 1 - 94.5% Stage 2 - 71.6% Stage 3 - 31.9% Stage 4 - 16%
46
Ultrasound score criteria for RMI
Ascites Bilateral cysts Multilocular Solid areas Metastases
47
Dysgerminoma proportion malignant vs benign
97% benign 3% malignant
48
LDH is raised in
Dysgerminomas (94%)
49
Dysgerminoma accounts for ___ ovarian malignancies and is bilateral in ____
1% 15%
50
5yr SR for Dysgerminoma
95%
51
Recurrence rate for Dysgerminoma
20%
52
Chemotherapy agent for Dysgerminoma
Platinum based
53
Abortion risk with surgery in 1st trimester of pregnancy
30%
54
Timing of surgery for ovarian masses in pregnancy
16-18 weeks
55
When should Surgery for dermoid cysts in pregnancy be done?
Second trimester When cyst >6cm If cysts bilateral
56
Adjuvant chemotherapy for ovarian malignancy in pregnancy
Methotrexate and cisplatin
57
5-hydroxyindoleactic acid (5-HIAA) is elevated in which ovarian masses?
Ovarian carcinoid tumours
58
AFP is secreted by
Yolk sac tumours AKA endodermal sinus tumour
59
Ovarian tumours that cause precocious puberty
Embryonal carcinoma Polyembryoma Granulosa cell tumour Choriocarcinoma of the ovary
60
Adnexal masses have a non-ovarian origin in ____ cases
10%
61
Granulosa cell tumours produce
Oestrogen
62
Granulosa cell tumours are associated with
Endometrial hyperplasia and cancer in 10%
63
Inhibin B levels are raised in _____ cancers
Granulosa cell tumours
64
Immature teratomas account for ___ germ cell tumours
20%
65
Characteristics of immature teratomas
Unilateral Arise from ectoderm, endoderm and mesoderm Commonly contain neural tissue Grade 1-3 No response to radiotherapy
66
Brenner tumour origin
Wolffian remnants Transitional epithelium
67
Clear cell carcinoma origin
Müllerian ducts

MRCOG part 2 (22 decks)

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