OB/GYN

Question 1

Ovarian Cancer Workup

Answer 1

• H&P
  
  • Focus menstrual/hormonal history (OCPs?, menarche, menopause, pregnancies?) and family history.
• CT C/A/P +/- pelvic US
• CBC, CMP
• CA-125, inhibin, beta-hCG, AFP, LDH (CEA?, CA 19-9?)
• Refer to genetic counselling

Question 2

TNMs

Answer 2

T

• T1: Limited to ovaries or fallopian tubes only
• T2: Addition of pelvic extension
• T3: Peritoneal mets or mets to retroperitoneal LNs

N

• N0: Neg nodes
• N1: Pos nodes

M

• M0: Neg mets
• M1: Pos mets

Question 3

Ovarian Cancer Staging

Answer 3

Question 4

Ovarian Cancer Treatment

Answer 4

Stage I (fertility desired)

• USO/BSO as indicated
• Comprehensive staging

All Stages (I-IV)

• Hysterectomy
• BSO
• Comprehensive staging

*Comprehensive staging = peritoneal washings, omentectomy, pelvic & para-aortic LND, examine all peritoneal surfaces and biopsy as indicated.

Question 5

In addition to hysterectomy and BSO, what else should be performed during surgery for ovarian cancer?

Answer 5

Comprehensive staging should also be performed. This includes the follow:

• Peritoneal washings
• Omentectomy
• Pelvic & para-aortic LND
• Examination of all peritoneal surfaces with biopsy as indicated

Question 6

If patient is a poor surgical candidate or there is a low likelihood of optimal cytoreduction, what is the treatment option?

Answer 6

Neoadjuvant therapy (chemo).

Re-evaluate for resection afterwards.

Question 7

Who gets adjuvant therapy and what is it?

Answer 7

All stages get adjuvant chemotherapy.

It is plantinum-based.

Question 8

Ovarian Cancer Follow-up

Answer 8

q3months x2 years, then q6months x3 years, then annually

• H&P (including pelvic exam)
• CA-125 and other tumor markers if initially elevated
• CT scans as indicated, but not routinely
• Refer for genetic coucselling if not already done

Question 9

What is a Krukenberg tumor?

Answer 9

Stomach cancer that has metastasized to the ovary.

• Pathology classically shows signet ring cells.