Ovarian Cancer

Question 1

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

Answer 1

Epithelial ovarian tumours

Question 2

3 most common subtypes of epithelial ovarian tumours?

Answer 2

• Serous tumours
• Mucinous tumours
• Endometroid tumours

Question 3

Most common malignant tumour of the ovary?

Answer 3

Serous cystadenocarcinoma

Question 4

What do mucinous tumours secrete?

Answer 4

Mucin

-Mucinous cystadenoma or mucinous cystadenocarcinoma

Question 5

Endometroid tumours are usually?

Answer 5

Malignant

Question 6

Other epithelial ovarian tumours include?

Answer 6

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

Question 7

What are sex cord/stromal tumours?

Answer 7

Tumours of the connective tissue of the ovary

Question 8

What is a fibroma?

Answer 8

Commonest sex cord/stromal tumour

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

Question 9

What is a thecoma?

Answer 9

Similar to fibroma but does secrete oestrogen

Question 10

What is a granulosa cell tumour?

Answer 10

• Potentially malignant and secretes oestrogens

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

Question 11

What is a sertoli Leydig cell tumour?

Answer 11

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

Question 12

What would a small yellow tumour within the ovary be?

Answer 12

Sertoli Leydig cell tumour

Question 13

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

Answer 13

Germ cell tumour

Question 14

Types of germ cell tumour?

Answer 14

• Mature cystic teratomas
• Immature teratomas
• Yolk sac tumour
• Choriocarcinoma
• Dysgerminoma

Question 15

What are mature cystic teratomas AKA?

Answer 15

Dermoid cyst

Question 16

What percentage of germ cell tumours are dermoid cysts?

Answer 16

95%

Question 17

Dermoid cysts are…?

Answer 17

Benign

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

Question 18

Why can dermoid cysts be so weird/spicy?

Answer 18

They have pluripotent potential

Question 19

Immature teratomas are?

Answer 19

Malignant and typically made of primative nerve tissue and mesenchymal tissue

Question 20

Aetiology of ovarian cancer?

Answer 20

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

Question 21

Risk factors for ovarian cancers?

Answer 21

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

Question 22

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

Answer 22

Decreases

Question 23

What are implicated in ovarian cancers?

Answer 23

• HNPCC/lynch syndrome

- BRCA1 & 2

Question 24

Presentation of ovarian cancers?

Answer 24

• 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

Question 25

What is raised in 80% of ovarian cancers?

Answer 25

Ca125

Question 26

What is the issue with Ca125?

Answer 26

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

Question 27

What is Ca125 good for?

Answer 27

Monitoring progression

Question 28

What is Ca125 a marker of?

Answer 28

Peritoneal and pleural inflammation

Question 29

What is Ca125 secreted by?

Answer 29

What is embryologically coelomic epithelium

Question 30

What else can Ca125 be raised in?

Answer 30

``` Endometriosis Liver disease PID Pregnancy Fibroids Pleural effusions Pericardial effusions Any peritoneal cancer ```

Question 31

What would not raise Ca125?

Answer 31

Renal stones (because retroperitoneal)

Question 32

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

Answer 32

CEA (Carcino-embryonic antigen)

Question 33

What do 60% of germ cell tumours produce?

Answer 33

A raised hCG and AFP

Question 34

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

Answer 34

Risk of malignancy index -USS score x menopausal score x Ca125

Question 35

How is the US score scored?

Answer 35

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

Question 36

How is menopausal status scored?

Answer 36

1 for premenopausal | 3 for postmenopausal

Question 37

How is Ca125 included in risk of malignancy index?

Answer 37

Measurement of IU/ml

Question 38

If risk of malignancy index is scored more than 200?

Answer 38

Chance of cancer is 75%

Question 39

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

Answer 39

The chance of cancer is 3%

Question 40

What score would get someone referred to gynaecology?

Answer 40

>200

Question 41

Other investigations for ovarian cancer?

Answer 41

CT/MRI | Biopsy- for full diagnosis

Question 42

Treatment for benign ovarain tumours?

Answer 42

Excision and drainage

Question 43

Treatment for ovarian epithelial tumours?

Answer 43

Chemotherapy and surgery

Question 44

To preserve fertility?

Answer 44

Conservative surgery (only removing 1 ovary)

Question 45

Non-epithelial tumour are often sensitive to?

Answer 45

Chemotherapy (good for preserving fertility)

Question 46

Prognosis of ovarian cancer?

Answer 46

5 year survival = around 40% overall

Question 47

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

Answer 47

HIGHER | 75%>40%

Question 48

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

Answer 48

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