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FRANZCOG Gynaecology > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

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1
Q

EOC per 100,000

a) Mortality rate
b) age standardised incidence

A

a) 7.4

b) 12.6

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2
Q

Lifetime risk of being diagnosed with ovarian cancer

A

1-1.5%

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3
Q

Risk of ovarian malignancy based on RMI?

A 
<25 = <3%
25-250 = 20%
>250 = 75% (sens 70%, spec 90%)

cut off 200 increased sensitivity (78%, 87%)

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4
Q

Most common type of epithelial ovarian cancer?

A

serous cystadenocarcinoma

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5
Q

Proportion of EOC caused by endometriod cell carcinoma?

A

10%

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6
Q

What type of cell is Brenne’s cell tumor derived from?

A

Transitional cell

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7
Q

Clear cell carcinoma is derived from what type of cell?

A

Mullerian

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8
Q

Normal ovarian volume in pre and post-menopausal women?

A

<20cm3 premenopausal

<10cm3 postmenopausal

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9
Q

List 7 criteria for a screening programme

A
  1. Condition: suitable for screening
  2. Test: suitable
  3. Treatment: effective + accessable
  4. Mortality/Morbidity reduced
  5. Benefit>Harm
  6. Sustainable
  7. Social/Ethics/Cost considered
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10
Q

Proportion of ovarian cancer diagnosed in late stages?

A

75%

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11
Q

Inheritance of BRCA?

A

Chromosome 17

Autosomal dominant

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12
Q

BRCA 1 80y cumulative risk

a) breast cancer
b) ovarian cancer

A

a) 72%

b) 44%

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13
Q

BRCA 2 80y cumulative risk

a) breast cancer
b) ovarian cancer

A

a) 69%

b) 17%

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14
Q

Frequent histological finding of serous tumor?

A

psammoma bodies

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15
Q

Tumor marker secreted by serous EOC?

A

Ca125

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16
Q

Risk factors for serous ovarian cancer?

A 
caucasian
nulliparous
chronic ovulator
nil COCP
HRT
Fanconi
Ashkenazi Jew
Icelandic
BRCA hx
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17
Q

Common USS findings serous ovarian cancer?

A

mixed solid/cystic
thick septations
calcification uncommon
frequently bilateral

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18
Q

Most important prognostic factor of serous adenocarcinoma?

A

stage at diagnosis

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19
Q

High grade serous ovarian cancer 5yr survival?

A

40%

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20
Q

Low grade serous ovarian cancer 5 year survival, advanced stage.

A

80%

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21
Q

Epithelial ovarian cancer low grade, early stage- should they receive chemotherapy?

A

No- does not improve survival.

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22
Q

Ca125 is elevated in what types of ovarian cancer?

A

80% of EOC, particularly non-mucinous tumors.

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23
Q

Mucinous tumors have elevation of what markers?

A

CEA, Ca199, +/- Ca125

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24
Q

Histology difference borderline vs. malignant mucinous tumor

A

> 10mm2 stromal invasion = malignant

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25
Grading mucinous tumors is dependent on what histological features?
% of solid component Grade I= no solid Grade II= <50% solid Grade III = >50% solid severe nuclear atypic can increase the grade
26
Mean age of diagnosis of mucinous adenocarcinoma of ovary?
60yo
27
Mucinous adenocarcinoma of the ovary is confirmed to the ovary in what proportion of cases?
95-98%
28
Proportion of mucinous adenocarcinoma found in ovary that is primary vs. secondary?
primary ~20% | secondary ~80%
29
USS appearance of mucinous cystadenocarcinoma
mural thickening solid/cystic components 95% unilateral areas of haemorrhage
30
MRI T1 appearance of mucinous cystadenocarcinoma
mucin = higher signal than water
31
Prognosis of stage I mucinous adenocarcinoma?
95%
32
Prognosis mucinous cystadenocarcinoma stage II or worse?
32%
33
Clear cell carcinoma histology of cells?
hobnail | clear
34
Risk factors for clear cell carcinoma of the ovary?
``` Lynch Syndrome Endometriosis Family history of ovarian cancer chronic ovulates (early menarche, late menopause, no COCP) ```
35
Most common type of tumor to be associated with paraneoplastic syndromes?
Clear cell ovarian cancer
36
USS findings clear cell ovarian cancer?
unilocular cystic smooth highly attenuated cystic portion
37
Prognosis 5yr stage I-IV clear cell carcinoma?
``` I = 85% II = 71% III= 35% IV= 16% ```
38
Oopherectomy with this type of EOC is usually curative...
Brenner's
39
6 types of sex-cord stromal ovarian cancer?
1. Granulosa-stromal 2. Androblastoma 3. Gynandroblastoma 4. Sex-cord tumor annular tubules 5. Sex-cord stromal tumors NOS 6. Steroid cell tumors
40
These tumors account for 70% of sex-cord stromal malignancies...
Granulosa-Stromal Cell Tumors
41
Ovarian tumor that can present with abnormal uterine bleeding?
Granulosa-stromal tumor
42
Ovarian tumor presenting with oligo/amonorrhoea?
Sertoli-Leydig cell tumor
43
Three classes of germ cell ovarian cancer
1. Primitive germ cell 2. Biphasic/triphasic teratoma 3. Monodermal teratoma and somatic type tumor associated with dermoid cysts
44
Types of ovarian cancer associated with elevated bhcg?
choriocarcinoma, embryonal, polyembryoma
45
Type of ovarian cancer associated with elevated AFP?
yolk sac | sometimes embryonal or polyembryoma
46
Ovarian cancer with elevated LDH
dysgerminoma
47
Most common type of ovarian germ cell cancer?
dysgerminoma (30-40%)
48
Elevated calcium and ovarian mass. Differentials?
Clear cell carcinoma Metastatic disease Dysgerminoma
49
Proportion of ovarian cancer caused by immature teratoma?
<1%
50
Most common type of malignancy initially developing within immature teratoma's?
SCC
51
Proportion of ovarian germ cell tumors caused by yolk sac carcinoma?
20%
52
Hormones commonly secreted by granuloma-stromal cell malignancy?
estrogen or androgens
53
Types of ovarian cancer causing virilisation?
Sertoli-Leydig
54
Proportion of ovarian cancer associated with familial/genetic predisposition?
10-20%
55
Immunohistochemistry for serous ovarian cancers if a) low grade b) high grade
a) KRAS/BRAF, often has borderline components | b) TP53 mutations and BRCA abnormalities
56
Recommended treatment for high and low grade serous ovarian cancer?
High grade - hysterectomy, debulking, BSO, staging biopsies - chemotherapy (adjuvant, neoadjuvant) Low grade - hysterectomy, debulking, lymph node biopsy, BSO - adjuvant chemotherapy only if spread or advanced stage Preferred chemo is carboplatin and paclitaxel
57
Preferred management of mucinous EOC?
1. aim for complete surgical resection 2. appendicectomy 3. advanced stage disease often treated with adjuvant platinum based chemotherapy (low efficacy compared to serous) 4. molecular therapies under development.
58
Treat meant for endometriod EOC?
- surgery for early stage cancers - adjuvant chemotherapy is associated with survival benefit for patients with grade 2 stage I cancers. - platinum based chemotherapy may benefit those with advanced stage disease (III, IV)
59
Treatment for clear cell EOC?
- Hysterectomy, bilateral salpingo-oopherectomy, omentectomy, staging biopsies - Adjuvant chemoradiation in some patients (platinum resistant)
60
Positive prognostici factors for clear cell carcinoma?
- stage is most important - positive lymph nodes - LVSI - positive prognostic factor PIK3CA mutation
61
5yr prognosis for Stage I-IV clear cell carcinoma?
``` I = 85% II= 71% III = 35% IV = 16% ```
62
RMI calculation (RCOG)
RMI = U x M x Ca125 ``` U= point for multilocular, solid, metastases, ascites, bilateral 0 = 0, 1 = 1, If 2 or more = 3 ``` M = 1 = premenopausal, 3 = postmenopausal
63
Sensitivity and specificity of RMI of 200 (RCOG)
78% sens | 87% specific
64
Management of asymptomatic, unilateral, unilocular cyst of <5cm in postmenopausal women? (RCOG)
Ca125 | If normal repeat evaluation in 4-6 months.
65
At what size should an ovarian cyst in a postmenopausal woman be investigated with a USS and Ca125? (RCOG)
1cm
66
At what cyst size should bilateral sapling-oopherectomy be offered in a postmenopausal woman? (RCOG)
>5cm
67
When should CT AP be performed for an ovarian cyst? (RCOG)
RMI >200
68
Ovarian cyst, RMI >200, CT AP performed, MDT review and felt to be low risk. What would be the recommended surgical management? (RCOG)
Pelvic clearance (TAH + BSO + omentectomy + peritoneal cytology) by a suitably trained gynaecologist
69
RCOG recommendations for genetic screening for BRCA? (RCOG)
- high grade or invasive EOC - EOC + 1x family member Ovarian/Breast Cancer First degree relative of you + first degree relative of them - 1x OC + 1xBC <50yo - 1x OC + 2BC <60yo - 1x BC +OC (one person, both ca) Colorectal cancer - 3x CRC - 2x CRC + 1x stomach/ovarian/urinary/endoetrial/small bowel. At least one <50yo.
70
Recommendations around fertility preservation with ovarian cancer? (O+G Mag)
Oocyte cryopreservation - 3000 babies born worldwide - available in NZ for women >16yo, <40yo - storage for a maximum of 10 years - use later on only funded if woman/partner proven infertility, <40yo, BMI <32, nonsmoker, no children. - must use ICSI due to hardening of zone pellucida live birth rates per oocyte 7.5-10% <30yo, 7-7.5% <35yo Ovarian preservation - not funded NZ - reimplanted with restoration of hormonal function. - 47.6% conceived at least once (50% naturally)
71
Ovarian cancer screening in high risk women? (O+G mag)
TVUSS and Ca125 lack sufficient sensitivity and specificity One study did four monthly= - more diagnosed at earlier stages - no proven improvement in mortality Current guidelines say no.
72
Non surgical prevention of ovarian cancer in BRCA carriers? | O&G mag
less effective than surgical prevention (98%) COCP can prevent, not as effective (50%) No data on implant or mirena small increased risk of breast ca in mirena users. Await results of trial looking at aspirin use. Hysterectomy with BSO- individualised. - no data re increased risk endometrial Ca. Maybe greater proportion serous histo. - may aid MHT (by permitting oestrogen-only MHT), or the use of Tamoxifen for breast cancer chemoprevention/adjuvant treatment of breast cancer
73
Overall incidence of a malignant symptomatic ovarian cyst in a premenopausal female?
1:1000
74
proportion of ovarian masses that are found to be non-ovarian in origin?
10%
75
Sensitivity of clinical examination in detection of ovarian masses?
15-51%
76
What tumor markers should be done in women <40yo?
LDH, AFP, hCG, Ca125
77
Management of premenopausal woman with 60mm simple cyst?
Yearly USS FU
78
At what size simple cyst should surgical intervention be considered in premenopausal woman?
>70mm.
79
Granulosa cell tumor management?
Surgery: - Stage 1A can perform USO for fertility. Must perform endometrial biopsy. - ideally TAH + BSO in peri/postmenopausal women No evidence for radiation or chemotherapy
80
Poor prognostic factors Granulosa cell tumors (4)?
advanced stage poorly differentiated sarcomatoid large >15cm
81
Management of Sertoli-leydig ovarian cancer?
USO if you/fertility sparing hysterectomy + BSO if peri/post menopausal insufficient evidence for chemo or radiation.
82
Most common germ cell ovarian cancer?
dysgerminoma.
83
Treatment dysgerminoma?
surgical resection, at least unilateral oopherectomy. chemosensitive with BEP if metastatic disease sensitive to radiation, but loss of fertility high risk.
84
TVUSS findings of dysgerminoma?
large, vascular, solid, lobulated, septae, haemorrhage, necrosis, calcifications
85
Treatment premenopausal immature teratoma?
- Surgery - Premenopausal - unilateral oopherectomy and surgical staging - contralateral ovarian wedge biopsy unnecessary - fertility considerations - Chemotherapy - Recommended for high grade lesions (2 or 3) - Patients with stage I grade I tumors only require surveillance - BEP is chemotherapy regime.

FRANZCOG Gynaecology (14 decks)

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