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Flashcards in Exam pt 2 Deck (151)
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1

what is the 4th most common CA in women

uterine CA

2

what is a hallmark of ovarian CA

intra-peritoneal spreads

3

2nd most common gynecologic malignancy with the highest mortality

Ovarian CA
*incidence increases w/ age and risk of relapse of advanced stage is 70%

4

pathogenesis hypotheses for ovarian CA

1. repeated ovulation/ trauma/ repair to ovarian epithelium allow genetic mutations and neoplasia
2. excess gonadtotropin secretion --> increased estrogen --> epithelial proliferation and potential for malignant transformation
3. starts as carcinoma insitu in fallopian tubes --> breaks free and invades ovaries

5

____% of primary ovarian tumors derive from epithelial cells

90% *mostly serous
(3% germ cells and 7% sex cord-stroma)

6

___% diagnosed with stage III/IV ovarian CA

75%

7

____% 5 year survival of advanced stage ovarian CA

20%

8

risk factors for ovarian CA

1. women w/ ovaries
2. long ovulation hx
3. unexplained infertility
4. nuliparity
5. fhx of breast or ovarian CA / BRCA**
6. diet
7. estrogen replacement
9. hx of endometriosis

9

factors that decrease your risk for ovarian CA

1. increased parity*
2. oral contraceptive use*
3. tubal ligation
4. hysterectomy

*decreased ovulation

10

symptoms of ovarian CA

bloating, fatigue, increased abdominal size, urinary urgency, constipation

11

how do u evaluate an adenxal mass?

1. transvaginal sonography (TVS)
-if normal rescan in 1 yr
-if abnormal evaluate tumor morphology index score, CA-125 biomarker, and color doppler

12

prevalence of adenxal mass

2-7%
*7.8% of premenopausal women had adenxal masses 2.5cm or larger on random u/s (ovarian cysts)

13

factors to consider when evaluating adenxal masses by TVUS

tumor size
borders
density
*morphology index score above 5 is concerning

14

what is an elevated CA-125 in a premenopausal woman and a postmenopausal woman

premenopausal >200
postmenopausal >35

*biomarker for ovarian CA but not specific!

15

how to treat an ovarian cyst

laparoscopy

16

tumor markers

HE4: ovarian CA
CA-125: ovarian and others
CEA: mostly GI tract
CA 19-9: mucinous tumors, pancreatic tumors
( if HE4 normal and CA125 elevated in premenopausal likely endometrosis)

17

screening for ovarian CA

there is no screening tool!
*just educate on signs

Can measure 5 protein in blood:
Transthyretin
apolipoprotein A-1
B2 microglobulin
Transferrin
CA 125 II

18

surgical staging for ovarian CA. What should be done?

1. hysterectomy
2. both tubes and ovaries (BSO)
3. pelvic washings
4. pelivic lymph nodes
5. periaortic lymph nodes
6. peritoneal biopsies
7. diaphram scraping
8. omentectomy/biopsy

19

stages for ovarianCA

Stage 1- stays where it started
Stage 2- spread next to the origin
Stage 3-spread outside pelvis
Stage 4- distally spread

20

treatment of ovarian CA

1. chemotherapy (IV or intraperitoneal)
2. platiunum and taxane (6 cycles of 21 days)
3. clinical trials
4. surgery

**Platinum drugs are the most effective (carboplatin or cisplatin)- but some are resistant to it

21

surveillance of ovarian CA after no evidence of disease

1. 5 yr prognosis
2. visit every 3 months for 2 years, then may space out
3. H and P
4. CA125
5. imaging?

22

what percent of ovarian CAs are genetic?

10%
of that:
BRCA1 ~70-75%
BRCA2~ 20%

23

what is a significant family hx of ovarian CA

-2 first degree relatives (Breast or ovarian CA OR 1

24

screening for ovarian CA if BRCA +

1. monthly BSE starting at 18
2. annual mammograms at 25
3. annual breast MRI
4. 2x yearly ovarin screening w/ us and CA125 at 35

25

how can u reduce ones risk of ovarian CA if they are BRCA +

1. screening
2. surgery
3. chemoprevention

*BSO reduces ~95%
Mastectomy ~40-50%

26

most common gyn malignancy in developed countries

endometrial CA

95% of uterine CA are endometrial, 5% are sarcomas

27

median age of endometrial CA

61

28

major risk factor for type I and type II endometrial CA

type I- unopposed estrogne
type II- age

29

80% of endometrial CA
race: caucasian > black
differentiation: well differentiated
histology: grade 1 or 2, endometrioid
Prognosis: favorable

type 1 endometrial CA

30

10-20% of endometrial CA
race: caucasian = black
differentiation: poorly differentiated
histology: grade 3, serous, clear cell, mucinous, etc.
Prognosis: poor

type 2 endometrial CA