Ovarian and Fallopian Tube Tumors

Question 1

What is the 5 year survival for ovarian cancer and why is it so low?

Answer 1

25-45%

No effective screening method for ovarian cancer

Question 2

Where are ovarian tumors most likely to arise?

Answer 2

65-90% from surface epithelium on the ovarian capsule

Germ cells, stroma are less common

Question 3

Where are metastatic tumors to the ovary likely to come from?

Answer 3

GI tract - Krukenberg tumors

Breast, endometrium

Question 4

How does ovarian cancer spread?

Answer 4

Direct exfoliation of cells from the ovary

Question 5

What can occur in the GI tract with advanced ovarian disease?

Answer 5

Carcinomatous ileus - intraperitoneal tumor spread causes ascites and encasement of bowel with tumor
Leads to malnutrition, starvation, cachexia, death

Question 6

How is ovarian cancer thought to arise?

Answer 6

Malignant transformation of ovarian tissue after prolonged periods of chronic uninterrupted ovulation

Question 7

What is the new theory on how ovarian cancer arises?

Answer 7

Thought that it arises from the fallopian tube

Question 8

What are the odds of developing ovarian cancer with BRCA 1 and 2?

Answer 8

BRCA1 - 30-50%

BRCA2 - 25%

Question 9

What are risk factors for ovarian cancer?

Answer 9

Uninterrupted ovulation, increasing age

Question 10

What are protective factors for ovarian cancer?

Answer 10

Ovulation suppression - OCPs, breast feeding, multiparity, chronic anovulation
Tubal ligation and hysterectomy* - thought to be due to decreased migration of carcinogens from lower GI tract up to ovaries

Question 11

What are the signs and symptoms of ovarian cancer?

Answer 11

Asymptomatic
Vague, nonspecific complaints
Lower abdominal pain
Early satiety
Fatigue
Urinary frequency
N/V
Ascites/SOB

Question 12

What can you see on physical exam with ovarian tumor?

Answer 12

Solid, fixed, irregular pelvic mass

Mets to the umbilicus can result in Sister Mary Joseph nodule

Question 13

How is ovarian cancer diagnosed?

Answer 13

Pelvic US
CT/MRI for spread of disease
Barium enema and IVP to rule out primary sources

Question 14

What should not be done for evaluation of ovarian cancer?

Answer 14

Paracentesis and cyst aspiration because it spreads through direct exfoliation

Question 15

What are tumor markers for ovarian cancer?

Answer 15

CA-125, AFP, LDH, and hCG

Question 16

How is ovarian cancer staged?

Answer 16

Surgical staging

TAH/BSO, omentectomy, peritoneal washings, sampling of pelvic/para-aortic lymph nodes

Question 17

What is the most common type of epithelial ovarian tumor?

Answer 17

Serous cystadenocarcinoma - large, cystic, bilateral

Question 18

What is the treatment of epithelial ovarian cancer ?

Answer 18

Surgery + combination chemo with carboplatin and paclitaxel + intraperitoneal cisplatin and paclitaxel
Follow with Ca-125 levels

Question 19

What are the characteristics of germ cell ovarian tumors?

Answer 19

95% benign, most commonly benign cystic mature teratoma (dermoid)
grow rapidly
unilateral
curable

Question 20

What is the treatment for dermoid cysts?

Answer 20

cystectomy because it has 1-2% chance of being malignant

Question 21

What are the most common malignany germ cell ovarian tumors?

Answer 21

Dysgermimomas
immature teratomas
endodermal yolk sac tumors
choriocarcinoma

Question 22

What serum tumor markers can be seen in germ cell ovarian tumors?

Answer 22

Dysgermimoma - LDH
Yolk sac - AFP
Choriocarcinoma - hCG
Undifferentiated carcinoma = AFP and hCG

Question 23

What is the most common ovarian malignancy in women

Answer 23

Germ cell tumors

Question 24

What are the typical signs of germ cell tumors?

Answer 24

Pelvic mass and abdominal pain

Pressure symptoms

Question 25

What is the treatment for ovarian germ cell tumors?

Answer 25

Unilateral salpingo-oophorectomy TAH/BSO if bilateral or childbearing complete Multiagent chemotherapy (BEP) typically required except for stage Ia dysgermimoma and immature teratomas

Question 26

What are the types of sex-cord stromal tumors?

Answer 26

Granulosa-theca cell tumors resemble ovaries - produce estradiol and inhibin A/B Sertoli-Leydig tumors resemble testes - produce testosterone Ovarian fibroma = not functional, occasionally associated with ascites

Question 27

What is Meigs syndrome?

Answer 27

Triad of ovarian tumor, ascites, right hydrothorax

Question 28

What histologic finding is pathognomonic for granulosa cell tumors?

Answer 28

Call-Exner bodies (grooved coffee-bean nuclei, cells arranged around central cavity)

Question 29

What are the consequences of granulosa cell tumors?

Answer 29

Endometrial hyperplasia/cancer due to estrogen production

Question 30

What are the signs/symptoms of sertoli-leydig tumors?

Answer 30

Virilization and hirsutism

Question 31

What is the treatment for sex cord stromal tumors?

Answer 31

Usually unilateral so unilateral SO | TAH/BSO for women past childbearing

Question 32

Is chemotherapy and radiation useful for sex cord stromal tumors?

Answer 32

No

Question 33

What are the signs and symptoms of fallopian tube cancers?

Answer 33

Asymptomatic | profuse watery discharge, pelvic pain, pelvic mass - Latzko's triad (pathognomonic but seen rarely)

Question 34

What is treatment for fallopian tube cancers?

Answer 34

Same as epithelial ovarian cancer TAH/BSO, omentectomy, etc Carboplain and paclitaxel CA-125 measurements

Question 35

What is the 5-year survival rate for epithelial ovarian cancer?

Answer 35

20%