Ovarian Cancer Flashcards

1
Q

What are the histological types of Ovarian cancer?

A

1) Epithelial tumors

2) Sex cord stromal tumors

3) Germ cell tumors

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2
Q

What is the most common histological type of Ovarian cancer?

A

Epithelial tumors

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3
Q

What is the rarest histological type of Ovarian cancer

A

Germ cell tumors

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4
Q

What is the lifetime risk of developing Epithelial Ovarian Cancer with BRCA 1 mutation?

A

50%

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5
Q

What is the lifetime risk for developing Epithelial Ovarian Cancer with BRCA 2 mutation?

A

30%

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6
Q

What is the lifetime risk for developing Epithelial Ovarian Cancer with Lynch 2 Syndrome mutation?

A

10%

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7
Q

What is another name for Lynch 2 Syndrome?

A

Hereditary Nonpolyposis Colorectal Cancer (HNPCC)

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8
Q

When do we genetic testing for mutations that → Ovarian Cancer?

A

1) Early onset Breast or Ovarian cancer (i.e., under 40/50 years old)

2) Family history of early onset Breast or Ovarian cancer

3) Women with high grade serous cancer

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9
Q

why do we do genetic testing for Ovarian cancer?

A

To trace other family members

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10
Q

What genetic mutations are associated with Epithelial Ovarian Cancer?

A

1) BRCA 1
2) BRCA 2
3) Lynch 2 Syndrome

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11
Q

What do you offer women with BRCA mutation?

A

Risk-reducing Bilateral Salpingo - Oophorectomy (BSO), between the ages of 35 & 40 or earlier if family complete

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12
Q

What do you offer women with Lynch 2 Syndrome mutation?

A

Risk- reducing Total Abdominal Hysterectomy & Bilateral Salpingo - Oophorectomy (TAH-BSO)

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13
Q

What are the most common presenting complaints in a patient suspected of Ovarian Cancer?

A

1) Asymptomatic in earlier stages

2) Pelvic & / or Abdominal pain

3) Non-specific GI symptoms

4) Metastatic signs & symptoms

5) P/V bleeding

6) Rectal bleeding

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14
Q

Why would a patient with Ovarian Cancer complain of dyspnea?

A

The dyspnea could be due to:

1) Ascites (pushing the diaphragm up)
OR
2) Pleural Effusion

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15
Q

What are the Non-specific GI complaints in a patient suspected of Ovarian Cancer?

A

♦ Dyspepsia
♦ Bloating
♦ Diarrhea & / Constipation
♦ Urinary frequency / urgency
♦ Weight loss
♦ Early satiety
♦ Nausea & vomiting
♦ Fatigue
♦ Dyspnea

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16
Q

What are the Metastatic signs & symptoms

A

♦ Brain: Headaches, Seizures, Focal motor deficits

♦ Lymph nodes: Supraclavicular or Inguinal lymphadenopathy

♦ Lungs: Cough, Hemoptysis, Chest pain

♦ Liver: Jaundice, Ascites

♦ Omentum: Abdominal pain (due to infiltration of omental fat)

♦ Bone: Local pain & swelling, Pathological fractures

17
Q

What signs you should be looking for in an Abdominal exam?

A

♦ Abdominal distension

♦ Fluid thrill → Ascites

♦ Pelvic lump
- nontender & fixed

♦ Lymph node mass

18
Q

What signs you should be looking for in a PV exam?

A

♦ Fullness in the fornices → Ascites

♦ Lump in the fornices

♦ Uterus feels separate from mass

19
Q

Pain in advance ovarian cancer can radiate where? and why?

A

Knee joint due to irritation of the obturator nerve

20
Q

For Ovarian Cancer, what questions should I ask in my HPC?

A

1) Do these symptoms occur more than 12 times a month?

Ans: most women with ovarian cancer have these symptoms for months

2) Have you ever felt a lump in your pelvis?

Ans: Adnexal mass increases the likelihood of cancer in postmenopausal women

21
Q

What is Dyspepsia?

A

Epigastric pain or burning that last for 1 month or more

22
Q

What symptoms are
associated Dyspepsia?

A

♦ Heartburn
♦ Nausea
♦ Regurgitation
♦ Bloating
♦ Belching

Note : Dyspepsia & Heartburn maybe indistinguishable

23
Q

For a Ovarian Cancer, what questions should I ask in my Past Medical Hx?

A

H/o HRT ?
H/o OCP use ?
H/o fertility medication use ?

24
Q

What lab investigations should be done in suspicion for Ovarian Cancer?

A

1st check CA-125 levels
- if more than 35 IU/mL order → TVUS or Abdominal U/S (if mass extends beyond pelvis or there are adhesions)

♦ Blood Tumor marker tests for:
postmenopausal women, check:
1) CA-125
2) Inhibin

for women under 40 check:
1) CA-125
2) Inhibin
3) Alpha fetoprotein (AFP)
4) Lactate dehydrogenase (LDH)
5) β hCG

Routine pre-operative labs:
♦ Baseline CBC
♦ LFTs
♦ U&E
♦ Creatinine
♦ ECG

25
Q

What are the types of Germ cell tumors?

A

1) Dysgerminoma

2) Teratoma

3) Endodermal sinus tumor

4) Choriocarcinoma

26
Q

What are the types of Teratoma

A

1) Immature

2) Mature

27
Q

What is another name for a mature teratoma

A

Dermoid cyst

28
Q

Which Teratoma is malignant?

A

Immature

29
Q

Which type of Teratoma is benign?

A

Dermoid cyst / Mature Teratoma

30
Q

What are the types of Epithelial Ovarian Cancer?

A

1) Serous carcinoma

2) Clear cell carcinoma

3) Endometrioid tumors

4) Mucinous tumors

5) Borderline tumors

6) Mixed cell tumors

31
Q

What is another name for a Borderline ovarian tumor?

A

Brenner ovarian tumor OR Transitional cell ovarian tumor

32
Q

What is the most common type of Epithelial Ovarian Cancer?

A

Serous carcinoma

33
Q

What is the 2nd most common type of Epithelial Ovarian Cancer?

A

Endometrioid tumors

34
Q

What is the least common type of Epithelial Ovarian Cancer?

A

1) Clear cell carcinoma

2) Mucinous tumors

3) Borderline tumors

4) Mixed cell tumors

35
Q

How do you estimate the risk of malignancy in ovarian masses?

A

1) Risk of Malignancy Index (RMI)

2) International Ovarian Tumor Analysis (IOTA) ultrasound rules

36
Q

When calculating the RMI score what formula is used?

A

RMI = CA-125 x U x M

CA-125 - units must be IU/mL

37
Q
A