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cOGTEXT > Ovarian Pathology > Flashcards

Ovarian Pathology Flashcards

1
Q

peak age of ovarian cancer?

A

75

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2
Q

are there precursor lesions in ovarian cancer?

A

no

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3
Q

most common type of primary ovarian tumour?

A

epithelial (arise from surface epithelium)

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4
Q

what is the main risk factor for ovarian cancer?

A

the number of times the woman ovulates

therefore COCP, several pregnancies and breastfeeding reduces risk

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5
Q

genetic predisposition to ovarian cancer?

A

1 first degree relative under 50 = 5% risk
2 first degree relatives under 50 = 25% risk
HNPCC (lynch syndrome)
BRCA1 and BRCA2 = 10-50% risk

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6
Q

how is BRCA risk managed?

A

women with these genes should attend regular screening and may be offered bilateral oophrectomy once their family is complete

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7
Q

what are the 4 categories of ovarian tumour?

A

epithelial
sex-cord/stromal tumours
germ cell tumours
metastatic tumours

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8
Q

5 types of epithelial ovarian tumour?

A 
endometrioid
mucinous
serous (most common ovarian cancer)
clear cell
brenner
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9
Q

two types of serous tumour with precursor lesions?

A

high grade serous carcinoma (precursor = serous tubal intra-epithelial carcinoma (STIC))
low grade serous carcinoma (precursor = serous borderline tumour)

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10
Q

can serous tumour be benign?

A

yes
serous cystadenomas
make up 20% of benign ovarian tumours

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11
Q

which epithelial ovarian tumours are associated with lynch syndrome?

A

endometrioid

clear cell

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12
Q

which epithelial ovarian tumour is associated with endometrial cancere?

A

endometrioid
histologically similar to endometrioid cancer
30% of women will also have a co-existent primary endometrial cancer

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13
Q

which epithelial ovarian cancer is associated with ovarian endometriosis?

A

clear cell

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14
Q

what is brenner tumour?

A

type of epithelial ovarian tumour
AKA urothelial like
tumour of transitional type epithelium

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15
Q

3 types of sex cord/stromal tumour?

A

granulosa cell
thecoma/fibroma
sertoli/leydig cell

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16
Q

describe granulosa cell tumours?

A

low grade but all are potentially malignant
75% secrete hormones (oestrogen)
contain cells with coffee bean nuclei and gland like spaces called call-exner bodies

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17
Q

symptoms of granulosa cell tumours?

A

precocious pseudopuberty
abnormal menstrual bleeding
post-menopausal bleeding
(all due to oestrogen secretion)

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18
Q

describe thecoma/fibroma?

A

usually benign

contain variety of cells such as theca cells or fibroblastic-type cells

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19
Q

symptoms of thecoma/fibroma?

A

may produce oestrogen causing uterine bleeding

can cause meigs syndrome (ascites and pleural effusion)

20
Q

how is meigs syndrome managed?

A

removal of tumour

21
Q

describe sertoli/leydig tumour?

A

rarest type
occur in young women (20s)
usually unilateral
usually non-functional but can be androgenic
stroma-derived fibroblasts may be seen if tumour contains leydig cells

22
Q

4 types of germ cell tumour?

A

teratoma
dysgerminoma
endodermal sinus/yolk sac tumour
choriocarcinoma

23
Q

who usually gets germ cell tumours?

A

20-25% of all ovarian neoplasms

usually affects children/young women

24
Q

describe teratoma?

A

common
usually benign
contain elements from all 3 germ layers

25
Q

what is a mature teratoma?

A

type of teratoma which may contain hair, teeth, epithelium, sebum etc
AKA dermoid cyst
95% of all germ cell tumours
(immature teratomas are rare)

26
Q

most common malignant germ cell tumour?

A

dysgerminoma

27
Q

what is dysgerminoma associated with?

A

gonadoblastoma in gonadal dysgenesis

increased HCG level

28
Q

how does yolk sac tumour usually present?

A

sudden pelvic mass

20% of woman also have a teratoma

29
Q

tumour markers in yolk sac tumour?

A

raised AFP

HCG usually normal

30
Q

what does choriocarcinoma secrete?

A

HCG

therefore may present with precocious pseudopuberty

31
Q

prognosis of choriocarcinoma?

A

poor prognosis

doesnt respond to chemo

32
Q

what cancers often metastasise to ovary?

A

endometrium
breast
pancreas
GI

33
Q

how do ovarian cancers spread?

A

trans-coelomically
can seed into peritoneal cavity
para-aortic lymph nodes
death results from intestinal blockage and cachexia

34
Q

how might ovarian cancer present?

A

usually present late with non-specific symptoms
only have GI symptoms in late stage
often have abdominal distension (due to ascites or mass itself)

35
Q

what is RMI?

A

risk of malignancy index

tool used to separate benign and malignant lesions

36
Q

how is RMI calculated?

A

RMI = US X menopausal score X CA125

37
Q

what is done if RMI is high?

A

CT/MRI is performed

US better for imaging cysts, CT/MRI done for malignant masses

38
Q

suspicious US findings on ovarian mass?

A 
complex mass with solid + cystic area
multi-loculated
thick septations
associated ascites
bilateral disease
39
Q

how is CA125 used in ovarian cancer?

A

sensitive but not that specific
raised in 80% of ovarian cancers
but also raised in other things to its a better indicator of disease progression at follow up than for diagnosis

40
Q

what else can cause raised CA125?

A 
endometriosis
peritonitis 
pregnancy
pancreatitis
ascites
other malignancies
41
Q

what other tumour markers are used in ovarian cancers?

A

CEA may be raised in ovarian cancer (esp in mucinous), mainly used to exclude mets from a GI primary cancer
65% of germ cell tumours produce HCG and AFP so these can be used to indicate response to treatment

42
Q

how is ovarian cancer staged?

A

FIGO system
1A = tumour limited to one ovary
1B = tumour limited to both ovaries
1C = cancer involving ovarian surface/rupture/surgical spill/tumour in washings
2A = extension or implants on uterus/fallopian tubes
2B = extension to other pelvic intraperitoneal
3A = retroperitoneal lymph node metastasis or microscopic extrapelvic peritoneal involvement
3B = macroscopic peritoneal metastasis beyond pelvis up to 2cm in dimension
3C = macroscopic peritoneal metastasis >2cm in dimension
4 = distant metastasis

43
Q

how are benign ovarian tumours managed?

A

excision or drainage

often cant distinguish between benign and malignant so diagnosis occurs after surgery

44
Q

how are epithelial ovarian tumours managed?

A 
usually surgery + chemo
- surgery = debulking
- chemo = usually adjuvant to surgery
chemotherapy can be used as first line therapy if unfit for surgery
chemo treatment of choice in relapse
45
Q

how are non-epithelial ovarian tumours managed?

A

fertility preservation important as these often occur in younger women
many are sensitive to chemo
limited surgery and chemotherapy can produce good results in many cases

46
Q

mean survival in ovarian cancer?

A

5 year survival is 40%

germ cell survival is better at 75%

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