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Gynecologic Oncology > Ovarian Masses > Flashcards

Ovarian Masses Flashcards

1
Q

Symptoms: Acute pain in a reproductive age patient

A

Hemorrhagic cyst, ruptured cyst, ectopic pregnancy, torsion

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2
Q

Symptoms: Unilateral, intermittent, acutely worsening, vomiting in reproductive age patient

A

Ovarian Torsion

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3
Q

Symptoms: Indolent with fevers, chills, discharge in reproductive age patient

A

TOA

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4
Q

Dysmenorrhea or pain with intercourse

A

Endometrioma

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5
Q

Ultrasound findings suggestive of malignancy

A

> 10 cm, solid components, septations, nodules, pappilary projections, doppler flow, free fluid

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6
Q

What is the size cut off for a cyst that can be observed?

A

10 cm

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7
Q

Criteria for GYN onc referral in a premenopausal patient

A

CA 125 > 200, Ascites, Evidence of abdominal or distant metastases

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8
Q

Criteria for GYN onc referral in a post menopausal patient

A

CA125 >20, Ascites, Evidence of abdominal or distant metastases, nodular or fixed mass, Size > 10 cm

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9
Q

CA 125 is specific for what type of ovarian cancer?

A

Epithelial

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10
Q

In what proportion of patients with epithelial ovarian cancers is CA 125 elevated?

A

80%

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11
Q

What is the recurrence rate of a simple cyst following aspiration?

A

40%

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12
Q

What are common diagnosis of adnexal masses during pregnancy?

A

Mature teratoma, corpus luteum

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13
Q

What is the most common ovarian malignancy during pregnancy?

A

Dysgerminoma

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14
Q

What is the risk of cancer in patient with an adnexal mass diagnosed during pregnancy?

A

1-7%

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15
Q

When does CA 125 peak during pregnancy

A

1st trimester

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16
Q

When is surgery for ovarian mass indicated in pregnancy?

A

indicated if symptomatic or concern for cancer based on imaging

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17
Q

How and when should you perform surgery for a patient with an adnexal mass diagnosed in pregnancy?

A

laparoscopic OR open approach in the second trimester

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18
Q

Ovarian cancer is the ____ most common gyn cancer

A

second

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19
Q

What is a woman’s baseline risk of ovarian cancer

A

1/70 lifetime risk

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20
Q

True or False: Ovarian cancer is the leading cause of death of gyn cancers

A

True

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21
Q

What are the main risk factors for ovarian cancer?

A

Older age, nulliparity, infertility, early menarche, late menopause

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22
Q

What are protective factors for ovarian cancer?

A

OCP use, Multiparity, lactation, tubal ligation

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23
Q

By how much does OCP use decrease ovarian cancer risk?

A

50% decrease

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24
Q

How many years do you need to use OCPs to get maximum benefit from an ovarian cancer risk standpoint?

A

5 years

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25
Q

What are the anatomic origin of high and low grade serous ovarian cancer?

A

Ovarian surface and fallopian tube epithelium

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26
Q

What is the anatomic origin of clear cell carcinoma?

A

endometrium

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27
Q

What is the anatomic origin of endometriod carcinoma?

A

endometrium

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28
Q

What percent reduction occurs with salpingectomy at time of hysterectomy in normal risk patients?

A

18%

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29
Q

What percent reduction occurs with tubal ligation?

A

10%

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30
Q

What percent of ovarian cancer is caused by hereditary syndromes?

A

5 - 10%

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31
Q

BRCA1 accounts for what percent of hereditary ovarian cancer?

A

70%

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32
Q

BRCA2 accounts for what percent of hereditary ovarian cancer?

A

20%

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33
Q

BRCA1 is associated with what lifetime risk of ovarian cancer?

A

40% lifetime risk

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34
Q

BRCA1 is associated with what lifetime risk of breast cancer?

A

80% lifetime risk

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35
Q

BRCA2 is associated with what lifetime risk of ovarian cancer?

A

20%

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36
Q

BRCA2 is associated with what lifetime risk of breast cancer?

A

50%

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37
Q

BRCA 1/2 is what type of inheritance?

A

Autosomal Dominant

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38
Q

Inheritance pattern for LYNCH syndrome?

A

Autosomal Dominant

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39
Q

What percentage of uterine cancer is related to LYNCH syndrome?

A

3%

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40
Q

What is the recommended screening for colonoscopy in LYNCH patients?

A

colonoscopy every 1-2 years starting at 20 - 25 yrs of age OR 2 years prior to the earliest family cancer

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41
Q

What is the recommended screening for endometrial biopsy in LYNCH patients?

A

Endometrial biopsy every 1 - 2 years starting at age 35

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42
Q

When do you recommend a risk reducing hysterectomy/BSO in patients with LYNCH syndrome?

A

mid 40s

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43
Q

What is the lifetime risk (by age 70) for colon cancer in LYNCH patient?

A

80% lifetime risk

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44
Q

What is the lifetime risk (by age 70) for endometrial cancer in LYNCH patient?

A

60% lifetime risk

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45
Q

What is the lifetime risk (by age 70) for ovarian cancer in LYNCH patient?

A

10% lifetime risk

46
Q

Cowden’s disease is associated with an increase in what types of cancer?

A

Breast cancer, endometrial cancer, colon cancer

47
Q

Li Fraumeni syndrome is associated with an increase in what types of cancer?

A

Breast and colon cancer

48
Q

Peutz Jeghers syndrome is associated with an increase in what types of cancer?

A

Breast, ovarian, colon

49
Q

What does SGO recommend in terms of ovarian cancer screening for BRCA patients?

A

Screen every 6 months with CA 125 and TVUS starting at age 30 - 35 years OR 5-10 years before earliest age of first cancer in family

50
Q

When during the menstrual cycle should you get a screening CA 125 in a BRCA patient?

A

Day 5

51
Q

When during the menstrual cycle should you get a screening TVUS in a BRCA patient?

A

Day 1-10

52
Q

What stages of ovarian cancer do not require adjuvant chemotherapy?

A

Stage IA, IB AND grade 1, 2

53
Q

What is the standard chemotherapy used in the treatment of ovarian cancer and how many cycles?

A

Carboplatin and Paclitaxel, 6 cycles

54
Q

What proportion of patients with ovarian cancer are diagnosed at stage I and what is the survival rate?

A

20% diagnosed at stage I, 70% survival rate

55
Q

What proportion of patients with ovarian cancer are diagnosed at stage II and what is the survival rate?

A

5% diagnosed at stage 2, 45% survival rate

56
Q

What proportion of patients with ovarian cancer are diagnosed at stage III and what is the survival rate?

A

58% diagnosed at stage 3, 20% survival rate

57
Q

What proportion of patients with ovarian cancer are diagnosed at stage IV and what is the survival rate?

A

17% diagnosed at stage 3, 10% survival rate

58
Q

What is the definition of Stage IA ovarian cancer?

A

Tumor limited to one ovary (capsule intact) or fallopian tube

59
Q

What is the definition of Stage IB ovarian cancer?

A

Tumor limited to BOTH ovaries (capsule intact) or BOTH fallopian tubes

60
Q

What is the definition of Stage IC1 ovarian cancer?

A

Tumor limited to one or both ovaries with capsule rupture DURING SURGERY

61
Q

What is the definition of Stage IC2 ovarian cancer?

A

Tumor limited to one or both ovaries with capsule rupture PRIOR to SURGERY

62
Q

What is the definition of Stage IC3 ovarian cancer?

A

Tumor/ Malignant cells in ascites or peritoneal washings

63
Q

What is the definition of Stage IIA ovarian cancer?

A

Extension or implants on the uterus

64
Q

What is the definition of Stage IIB ovarian cancer?

A

Extension to other pelvic tissues (colonic implants, retroperitoneal surface implants ect.)

65
Q

What is the definition of Stage IIIA ovarian cancer?

A

Positive retroperitoneal lymphnodes OR microscopic metastases beyond the pelvis

66
Q

What is the definition of Stage IIIB ovarian cancer?

A

Macroscopic abdominal peritoneal metastasis < 2 cm

67
Q

What is the definition of Stage IIIC ovarian cancer?

A

Macroscopic abdominal peritoneal metastasis > 2 cm

68
Q

What is the definition of Stage IVA ovarian cancer?

A

Pleural effusion with positive cytology

69
Q

What is the definition of Stage IVB ovarian cancer?

A

Parenchymal metastases and mets to extra-abdominal organs

70
Q

What is the most common type of ovarian cancer, what is the percentage?

A

Epithelial, 90%

71
Q

Of the epithelial ovarian cancers, what is the most common type, what is the percentage?

A

Serous, 50%

72
Q

High grade serous is associated with what genetic abnormalities?

A

BRCA1, BRCA2, TP53

73
Q

What is the percentage of ovarian cancer that is endometriod subtype?

A

25%

74
Q

What is the percentage of ovarian cancer that is Mucinous subtype?

A

10%

75
Q

What is the percentage of ovarian cancer that is clear cell subtype?

A

5%

76
Q

What is the treatment strategy for neoadjuvant chemotherapy in ovarian cancer

A

Carboplatin + Taxol q 3 weeks for 3 cycles, followed by cytoreductive surgery, followed by 3 more cycles or carbo/taxol q 3 weeks

77
Q

What agents are used for maintenance therapy in ovarian cancer patients?

A

Bevacizumab, or PARP inhibitors (Olaparib)

78
Q

What needs to be done for surveillance in terms of studies for ovarian patients?

A

CA 125 and physical exam

79
Q

What is the frequency and duration of surveillance for ovarian cancer patients?

A

every 3 months for 2 years and every 6 months for 3 years

80
Q

What are the 5 types of germ cell tumors?

A
  1. Immature teratoma
  2. Dysgerminoma
  3. Endodermal Sinus/yolk sac tumor
  4. Embryonal carcinoma
  5. Choriocarcinoma
81
Q

What is the most common germ cell tumor?

A

Dysgerminoma

82
Q

What are the tumor markers associated with Dysgerminoma?

A

LDH, bHCG

83
Q

What are the tumor markers associated with yolk sac tumors?

A

AFP

84
Q

What are the tumor markers associated with Choriocarcinoma?

A

bHCG

85
Q

What are the tumor markers associated with Embryonal carcinoma?

A

AFP, bHCG

86
Q

What are the tumor markers associated with immature teratoma?

A

AFP, LDH, CA125

87
Q

True or False: unilateral salpingo-oophorectomy is an option for fertility sparing treatment in a patient with a germ cell tumor

A

True

88
Q

What typical chemotherapy regimen is used with germ cell tumors?

A

BEP - Bleomycin, Etoposide, Carboplatin

89
Q

True or false: Germ cell tumors are NOT very chemotherapy sensitive

A

False

90
Q

What does the grading of an immature teratoma depend on?

A

amount of immature neuroectoderm

91
Q

What stage of disease of an immature teratoma DOES NOT require chemotherapy

A

Stage IA grade 1

92
Q

What are patients with dysgenetic gonads (phenoypic female with 46 XY) at increased risk for?

A

Dysgerminoma

93
Q

What pathology is associated with dysgerminomas?

A

epitheliod cells with mature lymphocytes with fibrous septae

94
Q

What gross pathology is associated with endomdermal sinus tumors/yolk sac tumors?

A

solid, necrotic, friable and yellowish tissue

95
Q

What cytologic characteristic is associated with endomdermal sinus tumors/yolk sac tumors?

A

Schiller-Duval bodies

96
Q

What germ cell tumor has the worst survival rates?

A

Yolk Sac Tumor

97
Q

Ovarian sex chord stromal tumors account for what proportion of ovarian cancer?

A

5%

98
Q

What are the two common sex chord stromal tumors?

A
  1. Granulosa cell tumors

2. sertoli-Leydig tumor

99
Q

What are the tumor markers for Granulosa cell tumors?

A

Inhibin A, Inhibin B

100
Q

What is the gross pathology of Granulosa cell tumors?

A

Solid/Cystic with blood fluid

101
Q

What cytologic characteristic is associated with granulosa cell tumors?

A

Call-Exner bodies , Coffee bean nuclei

102
Q

What concurrent procedure should always be performed in a patient with a granulosa cell tumor?

A

EMB or evaluation of endometrium

103
Q

What chemotherapy regimen should be used with a granulosa cell tumor?

A

BEP

104
Q

What is the survival rate for stage I-II granulosa cell tumor

A

85%

105
Q

What is the survival rate for stage III-IV granulosa cell tumor?

A

35%

106
Q

What is the gross pathology of Sertoli-Leydig tumors?

A

Sertoli tubules, clusters of leydig cells in intervening stroma

107
Q

What cytologic characteristic is associated with Sertoli-Leydig tumors?

A

Reinke Crystals - rod like cytoplasmic inclusions

108
Q

What chemotherapy regimen should be used with a Sertoli-Leydig Tumor?

A

BEP

109
Q

What is the 5 year survival rate for Sertoli-Leydig tumors?

A

70 - 90%

110
Q

What is MEIG syndrome?

A

FIBROMA associated with pleural effusions and ascites

111
Q

What ovarian tumor is associated with MEIG syndrome?

A

Ovarian fibroma

Gynecologic Oncology (11 decks)

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