staging ovarian classification cancers Flashcards by esther tutty

90 % of ovarian tumors are malignant epithelial tumors

- based to histology, immunohistochemistry and genetics what are the 5 subtypes

high grade serous 70%
endometriod carcinoma 10%
clear cell carcinoma 10% 
mucinous carcinoma 3%
low grade serous <5%

How well did you know this?

Not at all

Perfectly

What are the 3 subtypes of ovarian malignancy and their subtypes

epithelial 90+%
5 subtypes
-high grade serous
-low grade serous
- endometriod
-clear cell
- mucinous

Germ cell tumor 3%

dysgerminomas
yolk sac tumors
immature teratomas

Sex cord tumor 1-2%
mainly granolosa cell tumors

How well did you know this?

Not at all

Perfectly

High grade serous tumors
how do they present
What is the genetic mutation?

The most common ovarian cancer
80% of patients present with advanced stage disease
<10 % at presentation have tumors confined to the ovary
Not associated with borderline tumors
TP53 mutation and BRCA abnormalities resulting in chromosome instability

How well did you know this?

Not at all

Perfectly

Low grade serous tumors
how do they present
What is the genetic mutation?

Less common ovarian cancer
Usually contain a serous borderline component
KRAS and BRAF mutation

How well did you know this?

Not at all

Perfectly

Ovarian / peritoneal / tubal cancers have the same staging

What is stage 1?

Stage 1: tumor confined to the ovaries or the fallopian tubes

How well did you know this?

Not at all

Perfectly

What is Ovarian cancer stage T1a-No-Mo

IA: Tumor limited to 1 ovary (capsule intact) or fallopian tube; no tumor
on ovarian or fallopian tube surface; no malignant cells in the ascites or
peritoneal washings

B: Tumor limited to both ovaries (capsules intact) or fallopian tubes; no
tumor on ovarian or fallopian tube surface; no malignant cells in the
ascites or peritoneal washings
(1-5% of stage 1 cancers - second primary or metastatic?
- 1/3 obviously metastatic)

How well did you know this?

Not at all

Perfectly

What is Ovarian cancer stage T1c-No-Mo

IC: Tumor limited to 1 or both ovaries or fallopian tubes, with any of the
following:
IC1: Surgical spill
IC2: Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface
IC3: Malignant cells in the ascites or peritoneal washings

How well did you know this?

Not at all

Perfectly

What constitutes ovarian surface involvement?

Surface involvement of the ovary or fallopian tube should be considered present only when tumor cells are exposed to the peritoneal cavity. It is characterized by exophytic papillary tumor on the surface of the ovary or fallopian tube or on the outer surface of a cystic neoplasm
replacing these organs; rarely, a smooth ovarian tumor surface will be shown to have an exposed layer of neoplastic epithelium. Assessment
of surface involvement requires careful gross examination.

How well did you know this?

Not at all

Perfectly

Dense adhesions often cause rupture during surgery. Should these cases be
considered stage II?

Limited evidence suggests that dense adhesions of an apparent stage I tumor requiring sharp dissection (or when dissection results in tumor rupture) result in outcomes equivalent to tumors in stage II At
present, however, it is not clear whether upstaging based on dense
adhesions is warranted. A recent study suggests that it is not

How well did you know this?

Not at all

Perfectly

Does rupture during surgery worsen prognosis in the absence of excrescences,
ascites, or positive washings?

This is controversial. Whereas some studies found that intraoperative capsule rupture portends a higher risk of disease recurrence, others did not In a multivariable analysis, capsule rupture and positive cytologic washings remained independent predictors
of worse disease-free survival. Rupture should be avoided during primary surgery of malignant ovarian tumors confined to the ovaries.
Data from several studies suggest that stage I Clear cell is more frequently stage IC compared with other cell types, possibly because of an increased risk of rupture

How well did you know this?

Not at all

Perfectly

For ovarian cancer what is stage 2 disease

this is less then 10% of ovarian cancers

Stage II: Tumor involves 1 or both ovaries or fallopian tubes with pelvic extension (below pelvic brim) or primary peritoneal cancer

How well did you know this?

Not at all

Perfectly

What is stage 2a

IIA: Extension and/or implants on uterus and/or fallopian tubes and/ or ovaries

How well did you know this?

Not at all

Perfectly

What is stage 2b

IIB: Extension to other pelvic intraperitoneal tissues

How well did you know this?

Not at all

Perfectly

If tumor is in the sigmoid colon what stage is it?

Of note, the sigmoid colon is within the pelvis,

and therefore sigmoid involvement only is considered stage II

How well did you know this?

Not at all

Perfectly

How is stage 2 disease treated

All treated with adjuvant chemo therefore subclassification decided not essential

How well did you know this?

Not at all

Perfectly

What is stage 3 disease

Stage III: Tumor involves 1 or both ovaries or fallopian tubes, or primary peritoneal cancer, with cytologically or histologically confirmed spread to the peritoneum outside the pelvis and/or
metastasis to the retroperitoneal lymph nodes

How well did you know this?

Not at all

Perfectly

Stage 3 a
What is stage 3Ai
stage 3Aii
Stage 3A2

T3a- N0/1 - M0

IIIA1: Positive retroperitoneal lymph nodes only cytologically or histologically proven):
IIIA1(i) Metastasis up to 10 mm in greatest dimension
IIIA1(ii) Metastasis more than 10 mm in greatest dimension
IIIA2: Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes

How well did you know this?

Not at all

Perfectly

What is Stage 3 b

IIIB: Macroscopic peritoneal metastasis beyond the pelvis up to 2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes

How well did you know this?

Not at all

Perfectly

What is stage 3 C

IIIC: Macroscopic peritoneal metastasis beyond the pelvis more than 2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes (includes extension of tumor to capsule of
liver and spleen without parenchymal involvement of either organ

How well did you know this?

Not at all

Perfectly

What % of ovarian cancers present at stage 3?

IF the nodes are dissection what % of stage 1 pts will have nodal involvement

84% stage 3 c 
Stage 1 9% nodal involvement
II 36%
III 55% 
IV 88%

How well did you know this?

Not at all

Perfectly

What is stage 4 disease?

Stage IV: Distant metastasis excluding peritoneal metastases
d includes patients with
parenchymal liver/splenic metastases and extra-abdominal metastases;
12%–21% of patients present with stage IV disease

What is stage 4 A and B

Stage IVA: Pleural effusion with positive cytology

Stage IVB: Parenchymal metastases and metastases to extra-abdominal
organs (including inguinal lymph nodes and lymph nodes outside of the
abdominal cavity)

Epithelial ovarian cancer prognostic factors

Age 
Stage
Grade
Ploidy
Chemotherapy
residual disease 
molecular markers

risk factors for ovarian epithelial cancer

early menarche
late menopause
nullip or low parity
? ovulation induction
Infertility
BRCA
lynch
FHx (outside of known genetic abnormality)

What chemo is the current gold standard for epithelial ovarian cancer?

Taxsol and carboplatinum

ovarian germ cell tumors | what are the types and when do they present

Dysgerminoma yolk sac tumor Immature teratoma rapid growth symptomatic earlier 70-75% stage 1 15% dysgerminimas are bilateral

Ovarian germ cell tumors | where are they from

Derived from primordial germ cell tumors 10X increase in testicular analogues 25% ovarian neoplasms 5% ovarian cancers are GCT can arise from mediastinum and retroperitoneum usually puberty to the 30's

What is a dysgerminoma | What are the risk factors for it

5% occur in dysgenetic gonads 15% bilateral radiosensitive and chemo sensitive Histo- polygonal cells with abundant glycogen, thin septa, infiltrating lymphocytes and may have giant cells

How to treat dysgerminomas

Surgical staging, fertility sparing 1A needs no adjuvant treatment Chemo / RT if needed

Endodermal sinus tumor Histological signs what TM is raised

``` rapidly grows YS tumor hyaline bodies schiller duval bodies AFP raised ```

Immature teratomas

Stage IA no adjuvant tx maturation with chemotherapy multiple immature neural elements

What are types of sex cord tumors

``` Granulosa cell tumors theca fibromas sertoli stromal tumors Gynandroblastoma sex cord tumors with annular tubules ```

What is the histology for granulosa cell tumors

Call exner bodies coffee bean nucleai low grade usually indolent course juvenile variation

meigs syndrome

triad of a benign ovarian tumor, ascites and pleural effusions

gorlins syndrome

nevoid basal cell carcinoma syndrome that has autosomal dominant inheritance with an association to develop fibromas

What is a thecoma

``` Benign ovarian tuor Classified as sex cord stormal tumor E producing older woman mean age 59 present AUB and 20% have endometrial carcinoma ```

When and how do sertoli leydig cell tumors present

20-40 year olds usually low grade reink crystals adenoma or pick

Histology of krukunburg

signet ring cells | work up to locate primary site

protective factors against epithelial ovarian cancers

OCP risk reduction 80% with long term use 40% risk reduction in BRCA carriers and no increase in the risk of breast cancer Breastfeeding Multiparous TL RR by 50% Hysterectomy reduces ovarian cancer risk by 50% BSO risk reduction 95%

What increases CA 125 | What decreases CA 125

``` Increases Ovarian cancer endometriosis adenomyosis menstruation fibroids ovulation pregnancy ``` Decreased by Smoking Hysterectomy Caffeine

What TM are elevated in mucinous tumors

More likely Gastrointestinal, breast of GI malignancy CEA CA 19-9 CA 15-3 Serum inhibin may be elevated

Most common site of primary metastases to the ovary?

breast

The most common lymph node involved in ca cervix:

obturator

What is the breast cancer risk if 1X 1st degree relative has breast cancer? what if 2X 1st degree relatives have breast cancer? What is the baseline risk?

If you've had one first-degree female relative (sister, mother, daughter) diagnosed with breast cancer, your risk is doubled. If two first-degree relatives have been diagnosed, your risk is 5 times higher than average. Baseline risk 1/8

What is pagets disease of the vulva

Extramammary Paget disease, an intraepithelial adenocarcinoma, accounts for less than 1 percent of all vulvar malignancies [34]. Most patients are in their 60s and 70s and white. Pruritus is the most common symptom, present in 70 percent of patients. Vulvar Paget disease is similar in appearance to Paget disease of the breast. The lesion has an eczematoid appearance; it is well-demarcated and has slightly raised edges and a red background, often dotted with small, pale islands. It is usually multifocal and may occur anywhere on the vulva, mons, perineum/perianal area, or inner thigh. (See "Paget disease of the breast (PDB)".) Diagnosis is based upon characteristic histopathology (picture 3A-B). Vulvar biopsy should be performed in patients with suspicious lesions, including those with persistent pruritic eczematous lesions that fail to resolve within six weeks of appropriate antieczema therapy. Invasive adenocarcinomas may be present within or beneath the surface lesion in up to 25 percent of patients in small series (picture 4A-B) [34-38]. Women with Paget disease of the vulva should also be evaluated for the possibility of synchronous neoplasms, as approximately 20 to 30 percent of these patients have a noncontiguous carcinoma (eg, involving breast, rectum, bladder, urethra, cervix, or ovary) [39].

Who gets ovarian thecomas? How can they present?

``` Thecomas occur in older patients 11% androgenic (can produce virilizing sx) rarely malignant rarely bilateral treatment – simple oopherectomy ```

Ovarian cancer assoc with Peutz-Jegher syndrome?

Sex cord stromal tumor Jegher bombs lead to sex cord stromal tumors

What are thecomas ?

benign ovarian neoplasms sex cord stromal tumors E producing 60% AUB 20% endometrial carcinomas

What are the sex cord stromal tumors?

``` granulosa cells tumour – increased E2 thecoma fibroma Sertoli-leydig cell – increase testosterone Sertoli cell Leydig cell Gynandroblastoma ```

Types of vulval cancer - top 3 ?

``` squamous – 92% melanoma – 2-4% basal cell – 2-3% Bartholin gland – 1% metastatic – 1% verrucous - <1% sarcoma - <1% ```

Brainscape's Knowledge GenomeTM

staging ovarian classification cancers Flashcards

ovarian cancer

Brainscape's Knowledge Genome^TM