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Obs & Gyn > Ovarian oncology > Flashcards

Ovarian oncology Flashcards

1
Q

why do ovarian cancers tend to have worse prognosis

A

present late due to non-specific symptoms

  • > 70% of ptx present after it has spread beyond the pelvis
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2
Q

how can ovarian tumours be classified 4

A

eipthelial cell tumours

dermoid cysts/ Germ cell tumours

sex cord-stromal tumours

metatsis from other tumour sites

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3
Q

what is the most common ovairian tumour type

A

epithelial cell tumours

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4
Q

subtypes of epithelial cell ovarian tumours 5

A

serous tumours (most common)

endometrioid carcinomas

clear cell tumours

mucinous tumours

undifferentiated tumours

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5
Q

are dermoid cyst/germ cell tumours benign or malignant

A

benign

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6
Q

what can dermoid cyst/germ cell tumours include 4

A

various types of tissue such as skin, teeth, hair and bone

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7
Q

what are dermoid cyst/germ cell tumours associated with 1

A

ovarian torsion

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8
Q

what biochemical markers are dermoid cyst/germ cell tumours associated with 2

A

raised alpha-fetoprotein (å-FP)

raised human chorionic gonadotrophin (hCG)

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9
Q

what do sex cord-stromal ovarian tumours arise from 2

A

sex cords - embyronic structures assocaited with the follicles

stroma - connective tissue

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10
Q

main types of sex cord-stromal ovarian tumours 2

A

sertoli-leydig cell tumours

granulosa cell tumours

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11
Q

what is a common metatsis to the ovaries and the name of the tumour

A

Krukenberg tumour
-usuusually from a GI tract cancer (particularly the stomach)

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12
Q

characterisitc finding in krukenberg tumours 1

A

‘signet-ring’ cells on histology
-look like signet rings under a microscope

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13
Q

risk factors for ovarian tumours 6

A

age (peak age 60)

BRCA1 and BRAC2 genes (consider FHx)

increased No of ovulations

obesity

smoking

recurrent use of clomifene (infertility drug)

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14
Q

What else can impact the risk of ovarian cancer
-give some examples 3

A

increased number of ovulations-> incresed risk of ovarian cancer

examples
-early-onset periods
-late menopause
-no pregnancies

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15
Q

what is a protective factor for ovarian cancer
-give some examples 3

A

factors that stop ovulation or reduce the number of lifetime ovulations-> reduce the risk of ovarian ca

examples
-combined contraceptive pill
-breastfeeding
-pregnancy

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16
Q

what is important when assessing someone with a potential ovarian cancer

A

often presents with very non-sepcific syx

-in older women keep the possibility of ovarian cancer in mind and have a low threshold for considering further investigations

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17
Q

symptoms of ovarian cancer 8

A

abdo bloating

early satiety (feeling full after eating)

loss of appetite

pelvic pain

urinary syx - frequency / urgency

weight loss

abdo or pelvic mass

ascites

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18
Q

what can an ovarian mass compress and how does this manifest as symptoms

A

can press on the obturator nerve and cause referred hip or groin pain

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19
Q

what symptoms after examination would prompt a direct 2-week-wait referral for ovarian cancer 3

A

ascites

pelvic mass -unless clearly due to fibroids

abdominal mass

20
Q

what is the most important initial investigation in a possible ovarian cancer?

A

CA125 blood test

21
Q

what other investigation is important for possible ovarian cancer 1

A

pelvic ultrasound

22
Q

what is used to estimate the risk of an ovarian mass being malignant 1

A

risk of malignancy index (RMI)

23
Q

what does the risk of malginancy index take into account when identifying if an ovarian mass is malignant 3

*-what is the calculation

A

menopausal status

ultrasound findings

CA125 levels

*-RMI= UxMxCA125

24
Q

what ultrasound findings are used in the risk of malignancy index for ovarian cancer

-what is the menopausal status score

A

Multilocular
Solid areas
Ascites
Intra abdominal metastasis
Score
0 = 0
1 = 1
2/+ = 3

  • 1- pre
    3- post
25
Q

an example risk of malgnancy index calculation for ovairna cancer

A

Example
60y, Postmenopausal, CA125 is 300, Bilateral complex ovarian masses, solid areas, ascites.

Therefore RMI = U3 X M3 X 300 = 2700

26
Q

what value of the risk malginacy index is used to indicate a probable malignancy in ovarian cancer

A

RMI >200

27
Q

further investigaitons in secondary care for ovarian cancer 3

A

CT scan
-establish diagnosis and stage the cancer

histology (tissue sample)
-using a CT guided biopsy, laparoscopy or laparotomy

paracentesis (ascitic tap)
-can be used to test the ascitic fluid for cancer cells

28
Q

what investigations are important for a COMPLEX OVARIAN MASS in women UNDER 40 (2)

A

check for possible germ cell tumours

so
-alpha-fetoprotein (å-FP)
-human chorionic gonadotropin (HCG)

29
Q

what non-malignant causes of a raised CA125 can be found 6

A

endometriosis

fibroids

adenomyosis

pelvic infection

liver disease

pregnancy

30
Q

regarding staging ovarian cancer
define stage 1

A

confined to ovary

31
Q

regarding staging ovarian cancer
define stage 2

A

spread past ovary but inside the pelvis

32
Q

regarding staging ovarian cancer
define stage 3

A

spread past pelvis but inside the abdomen

33
Q

regarding staging ovarian cancer
define stage 4

A

spread outside the abdomen (distant metastasis)

34
Q

how can types of epithelial ovarian cancer be split

A

2 types

high grade serous

or arise from ovarian surface epithelium and Mullerian inclusion cysts

35
Q

what do high grade serous epithelial ovarian tumours resemble

A

fallopian tube mucosa

36
Q

what genetic mutations are found in high grade serous epithelial ovarian tumours

A

P53

37
Q

what types of epithelial ovarian cancer arise from ovarian surface epithelium and mullerian inclusion cysts 4

A

endometriod

clear cell

mucinous

low grade serous

38
Q

how do ovarian cancers spread 3

A

direct extension (transcoelemic)

exfoliation into the peritoneal cavity

lymphatic invasion

39
Q

screening for ovarina cancer

A

current trials but no evidence so far to support screening even in high risk women

40
Q

ovarian cancer gene mutations 3

A

BRCA1- chromosome 17q

BRAC2 chromosome 13q

lynch syndrome -HNPCC
-mutation in mismatch repiar genes

*-also undiscovered genes

41
Q

what cancer preentations suggest famial cause due to BRCA 1, BRCA2 and HNPCC 3

A

early onset breast cancer <50y

male breast cancer

bilateral breast cancer

42
Q

what risk reducing surgery is available for high risk ovarian cancer patients

*-what reduction in risk does this cause 2

A

prophylatic bilateral salpingo-oophrectomy

-important to remove ovary AND entire fallopian tube

*- 96% ovarian ca reduction
-53% breast ca reduction

43
Q

what value of the risk malginacy index is used to indicate a probable malignancy in ovarian cancer

A

RMI >200

44
Q

overview of ovarian cancer managment. 4

A

all cases discussed at MDT
-guides investigations eg biopsies
-decison on management

chemo-timing?, drugs?

surgery- appropriate?, timing?, by whom?

45
Q

surgery overview of ovarina cancer

A

midline laparotmy

-TAH, BSO, Washings, Omentectomy +/- appendicetomy / resection of peritoneal deposits
Ultra-radical – splenectomy, bowel resection, peritoneal stripping
Aim to leave NO residual disease or OPTIMAL CYTOREDUCTION (less than 1cm)

46
Q

chemo overview of ovarian cacner

A

neo adjuvant
-in patients with advanced disease
-poor perfomarance status

adjuvant
-post op MDT decison

1st line include platinum agent in combo
-carboplatin
-paclitaxel in combo

*intraperitoneal as part of clinical trials

47
Q

other opitnos for ovarian cancer managemnt 2

A

biological agent s
-antiangiogenesis

hormonal therapy
-tamoxifen/ aromatase inhibiotr

Obs & Gyn (23 decks)

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