Ovarian Cancer Flashcards

1
Q

What accounts for 65-70% of all ovarian tumours?

A

Epithelial ovarian tumours

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2
Q

3 most common subtypes of epithelial ovarian tumours?

A
  • Serous tumours
  • Mucinous tumours
  • Endometroid tumours
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3
Q

Most common malignant tumour of the ovary?

A

Serous cystadenocarcinoma

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4
Q

What do mucinous tumours secrete?

A

Mucin

-Mucinous cystadenoma or mucinous cystadenocarcinoma

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5
Q

Endometroid tumours are usually?

A

Malignant

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6
Q

Other epithelial ovarian tumours include?

A
  • Brenner’s tumours (essentially benign and show islands of transitional epithelium in a fibrous stroma)
  • Clear cell carcinoma
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7
Q

What are sex cord/stromal tumours?

A

Tumours of the connective tissue of the ovary

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8
Q

What is a fibroma?

A

Commonest sex cord/stromal tumour

  • Benign collagenous
  • Does not produce oestrogen
  • Spindle cell tumour
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9
Q

What is a thecoma?

A

Similar to fibroma but does secrete oestrogen

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10
Q

What is a granulosa cell tumour?

A
  • Potentially malignant and secretes oestrogens

- Composed of cells resembling the granulosa cells lining the Graafian follicles

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11
Q

What is a sertoli Leydig cell tumour?

A
  • Very rare
  • May produce androgens causing virilization
  • Usually small yellow tumour within the ovary
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12
Q

What would a small yellow tumour within the ovary be?

A

Sertoli Leydig cell tumour

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13
Q

What tumour encompasses 15-20% of all ovarian tumours?

A

Germ cell tumour

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14
Q

Types of germ cell tumour?

A
  • Mature cystic teratomas
  • Immature teratomas
  • Yolk sac tumour
  • Choriocarcinoma
  • Dysgerminoma
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15
Q

What are mature cystic teratomas AKA?

A

Dermoid cyst

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16
Q

What percentage of germ cell tumours are dermoid cysts?

A

95%

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17
Q

Dermoid cysts are…?

A

Benign

-Can have sebum, hair, teeth, nervous tissue, respiratory tissue, intestinal epithelium and thyroid tissue

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18
Q

Why can dermoid cysts be so weird/spicy?

A

They have pluripotent potential

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19
Q

Immature teratomas are?

A

Malignant and typically made of primative nerve tissue and mesenchymal tissue

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20
Q

Aetiology of ovarian cancer?

A
  • Older women
  • Peak age = 75 y/o
  • 5-10% of cases have genetic predisposition and FHx increases risk
21
Q

Risk factors for ovarian cancers?

A
  • No. of times someone ha ovulated= biggest RF (more=more risk)
  • Nulliparity
  • Endometriosis
22
Q

COCP and Breast feeding increases/decreases risk of ovarian cancer?

A

Decreases

23
Q

What are implicated in ovarian cancers?

A
  • HNPCC/lynch syndrome

- BRCA1 & 2

24
Q

Presentation of ovarian cancers?

A
  • May be asymptomatic and often presents late as symptoms are non-specific
  • Bloating, early satiety, abdo pain or swelling, constipation and menstrual changes
  • Any woman with new onset IBS features who is >50 ovarian cancer must be suspected
25
Q

What is raised in 80% of ovarian cancers?

A

Ca125

26
Q

What is the issue with Ca125?

A

Raised in ovarian cancers but also many other conditions so lacks sensitivity and specificity when used alone

27
Q

What is Ca125 good for?

A

Monitoring progression

28
Q

What is Ca125 a marker of?

A

Peritoneal and pleural inflammation

29
Q

What is Ca125 secreted by?

A

What is embryologically coelomic epithelium

30
Q

What else can Ca125 be raised in?

A
Endometriosis 
Liver disease 
PID 
Pregnancy 
Fibroids 
Pleural effusions 
Pericardial effusions 
Any peritoneal cancer
31
Q

What would not raise Ca125?

A

Renal stones (because retroperitoneal)

32
Q

What else apart from Ca125 may be raised in ovarian cancer?

A

CEA (Carcino-embryonic antigen)

33
Q

What do 60% of germ cell tumours produce?

A

A raised hCG and AFP

34
Q

What is used to differentiate between benign and malignant ovarian cancers?

A

Risk of malignancy index

-USS score x menopausal score x Ca125

35
Q

How is the US score scored?

A

1 point each for the following:

  • Multilocular cysts
  • Solid areas
  • Mets
  • Ascites
  • Bilateral lesions

U= 0 if none, U=1 if one and U=3 if score 2-5

36
Q

How is menopausal status scored?

A

1 for premenopausal

3 for postmenopausal

37
Q

How is Ca125 included in risk of malignancy index?

A

Measurement of IU/ml

38
Q

If risk of malignancy index is scored more than 200?

A

Chance of cancer is 75%

39
Q

If the score in risk of malignancy risk index is <30?

A

The chance of cancer is 3%

40
Q

What score would get someone referred to gynaecology?

A

> 200

41
Q

Other investigations for ovarian cancer?

A

CT/MRI

Biopsy- for full diagnosis

42
Q

Treatment for benign ovarain tumours?

A

Excision and drainage

43
Q

Treatment for ovarian epithelial tumours?

A

Chemotherapy and surgery

44
Q

To preserve fertility?

A

Conservative surgery (only removing 1 ovary)

45
Q

Non-epithelial tumour are often sensitive to?

A

Chemotherapy (good for preserving fertility)

46
Q

Prognosis of ovarian cancer?

A

5 year survival = around 40% overall

47
Q

Germ cell tumours have a higher/lower survival rate than other ovarian cancers?

A

HIGHER

75%>40%

48
Q

what are all the different stages of figo staging of ovarian cancer?

A

1 - only in ovaries
2- local invasion
3 - close mets
4 - distant mets


1A tumour limited to one ovary
1B tumour limited to both ovaries
1C cancer involving ovarian surface/rupture/surgical spill/tumour in washings

2A Extension or implants on uterus/fallopian tube
2B Extension to other pelvic intraperitoneal

3A Retroperitoneal lymph node – metastasis or microscopic extrapelvic peritoneal involvement
3B macroscopic peritoneal metastasis beyond pelvis up to 2cm in dimension
3C macroscopic peritoneal metastasis >2cm in dimension

4 Distant metastasis