Ovary Flashcards
Ovarian histopathological classification
Serous tumors
Mucinous
Endometrioid
Clear cell
Brenner tumors
Seromucinous
Undifferentiated
Mesenchymal
Sex cord stromal tumor:
pure stromal
Pure sex cord
Mixed sex cord stromal tumor
Germ cell: dysgerminoma, yolk sac,embryonal, mature teratoma, immature teratoma,mixed
Miscellaneous
Soft tissue tumors
Lymphoid and myeloid tumors
risk factors for ovarian carcinoma
age: advanced age
chronic estrogen stimulus:
early menarche
late menopause
1st parity >35 years
infertility
nulliparity
anovulation
ovulation inducing drug
endometriosis
HRT
dietary
environmental
* smoking
* obesity
* viral infection*
family history
geography
genetic
*BRCA1
*BRCA2
*MLH1, MSH2, PMS1, PMS2, MSI
HNPCC
factors reducing risk of ovarian cancer
OCP
patient having children, multiparity
breast fed
physical activity
tubal ligation, hysterectomy
BRCA 1 is responsible for which cancers
breast 50-80%
ovary 15-45%
bone
colon
prostate
BRCA 2 is responsible for which cancer
breast
ovary
prostate
pancreas
GB
melanoma
molecular testing can be done in carcinoma ovary
BRCA 1/2
HRD
MSI
MMR
TMB
BRAF
FR alpha
RET
NTRK
chemotherapy choice in case of platinum resistance ovarian cancer
cyclo+bevacizumab
docetaxel
etoposide
gemcitabine
liposomal doxorubicin
paclitaxel
topotecan
topotecan+bevacizumab
Prognostic factors for CA ovary
Tumor related
1. FIGO stage- most important prognostic factor. 5 yr survival of stage IA, grade ½ is 90% after Sx alone
2. Grade- higher grade is adverse prognostic factor
3. Histologic subtype- endometroid is better, mucinous and clear cell type is worse as chemoresistant
4. Volume of post operative residual disease
5. Pre-op Ascites is worse
6. Raised CA 125 after 3 cycle if CT indicate chemoresistant disease
Patient related
1. Age > 65 yrs adverse prognostic factor
2. Germ line mutation in BRCA 1/2 is associated with improved prognosis.
Survival for different stage of Ca ovary
Stage 5 yr survival
Stage I 80%
Stage II 60%
Stage IIIA 40%
IIIB 25%
IIIC 23%
Stage IV 10%
Indication of BRCA testing ( Devita)
*Patients with family members with known deleterious mutations in BRCA1/2, PALB2, CHEK2, ATM, or other genes associated with hereditary breast cancer
*Patients with early-onset breast cancer (usually age <50 y) Patients with triple-negative breast cancer (up to age 65 y)
*Patients with personal history of second breast cancer, or ovarian cancer, or male breast cancer
*Patients with one or more first-degree relatives with breast can- cer, ovarian cancer, or male breast cancer
*Patients with multiple family members with cancers that may be associated with hereditary breast cancer syndromes including pancreatic, prostate, colorectal, or uterine cancers, or cancers associated with Li-Fraumeni syndrome
*Patients who are potential candidates for adjuvant PARP inhibitor therapy (see the following text)
*Patients with metastatic breast cancer
Indication of BRCA testing bethesda
Personal diagnosis of early onset breast cancer (age ≤45)
Personal diagnosis of breast cancer from age 46 to 50
unknown or limited family history
multiple primary breast cancers
at least one relative* with a history of breast, ovarian, pancreatic or prostate cancer
Diagnosed at any age with:
≥1 close blood relative with breast cancer diagnosed at age ≤50 years or ovarian,
pancreatic, metastatic, intraductal/cribriform histology or high/very high risk group prostate cancer at any age
≥3 total diagnoses of breast cancer in a patient and/or close blood relatives
-Personal history of triple negative (ER-, PR-, HER2-) breast cancer Personal history of male breast cancer OR family history of male breast cancer in at least one relative*
-Personal history of lobular breast cancer and known personal or family history of diffuse gastric cancer
-History of Ashkenazi Jewish ancestry
Chemotherapy neoadjuvant or adjuvant in choice
High grade serous/ endometrioid/ clear cell carcinoma/ carcinosarcoma
Preferred: paclitaxel/ carboplatin
Paclitaxel/carboplatin/ bevacizumab + maintenance bevacizumab
Other:
Paclitaxel weekly + carboplatin weekly
Docetaxel + carboplatin
Carboplatin + liposomal doxorubicin
Mucinous carcinoma
5FU/ leucovorin/ oxaliplatin ± bevacizumab
Capecitabine/oxaliplatin ± bevacizumab
What is paraneoplastic syndrome
These are tumor-associated syndromes where the symptoms are not directly related to the spread of the tumor or to the elaboration of hormones indigenous to the tumor tissue.
