Ovarian Cancer

Question 1

What are the histological types of Ovarian cancer?

Answer 1

1) Epithelial tumors

2) Sex cord stromal tumors

3) Germ cell tumors

Question 2

What is the most common histological type of Ovarian cancer?

Answer 2

Epithelial tumors

Question 3

What is the rarest histological type of Ovarian cancer

Answer 3

Germ cell tumors

Question 4

What is the lifetime risk of developing Epithelial Ovarian Cancer with BRCA 1 mutation?

Answer 4

50%

Question 5

What is the lifetime risk for developing Epithelial Ovarian Cancer with BRCA 2 mutation?

Answer 5

30%

Question 6

What is the lifetime risk for developing Epithelial Ovarian Cancer with Lynch 2 Syndrome mutation?

Answer 6

10%

Question 7

What is another name for Lynch 2 Syndrome?

Answer 7

Hereditary Nonpolyposis Colorectal Cancer (HNPCC)

Question 8

When do we genetic testing for mutations that → Ovarian Cancer?

Answer 8

1) Early onset Breast or Ovarian cancer (i.e., under 40/50 years old)

2) Family history of early onset Breast or Ovarian cancer

3) Women with high grade serous cancer

Question 9

why do we do genetic testing for Ovarian cancer?

Answer 9

To trace other family members

Question 10

What genetic mutations are associated with Epithelial Ovarian Cancer?

Answer 10

1) BRCA 1
2) BRCA 2
3) Lynch 2 Syndrome

Question 11

What do you offer women with BRCA mutation?

Answer 11

Risk-reducing Bilateral Salpingo - Oophorectomy (BSO), between the ages of 35 & 40 or earlier if family complete

Question 12

What do you offer women with Lynch 2 Syndrome mutation?

Answer 12

Risk- reducing Total Abdominal Hysterectomy & Bilateral Salpingo - Oophorectomy (TAH-BSO)

Question 13

What are the most common presenting complaints in a patient suspected of Ovarian Cancer?

Answer 13

1) Asymptomatic in earlier stages

2) Pelvic & / or Abdominal pain

3) Non-specific GI symptoms

4) Metastatic signs & symptoms

5) P/V bleeding

6) Rectal bleeding

Question 14

Why would a patient with Ovarian Cancer complain of dyspnea?

Answer 14

The dyspnea could be due to:

1) Ascites (pushing the diaphragm up)
OR
2) Pleural Effusion

Question 15

What are the Non-specific GI complaints in a patient suspected of Ovarian Cancer?

Answer 15

♦ Dyspepsia
♦ Bloating
♦ Diarrhea & / Constipation
♦ Urinary frequency / urgency
♦ Weight loss
♦ Early satiety
♦ Nausea & vomiting
♦ Fatigue
♦ Dyspnea

Question 16

What are the Metastatic signs & symptoms

Answer 16

♦ Brain: Headaches, Seizures, Focal motor deficits

♦ Lymph nodes: Supraclavicular or Inguinal lymphadenopathy

♦ Lungs: Cough, Hemoptysis, Chest pain

♦ Liver: Jaundice, Ascites

♦ Omentum: Abdominal pain (due to infiltration of omental fat)

♦ Bone: Local pain & swelling, Pathological fractures

Question 17

What signs you should be looking for in an Abdominal exam?

Answer 17

♦ Abdominal distension

♦ Fluid thrill → Ascites

♦ Pelvic lump
- nontender & fixed

♦ Lymph node mass

Question 18

What signs you should be looking for in a PV exam?

Answer 18

♦ Fullness in the fornices → Ascites

♦ Lump in the fornices

♦ Uterus feels separate from mass

Question 19

Pain in advance ovarian cancer can radiate where? and why?

Answer 19

Knee joint due to irritation of the obturator nerve

Question 20

For Ovarian Cancer, what questions should I ask in my HPC?

Answer 20

1) Do these symptoms occur more than 12 times a month?

Ans: most women with ovarian cancer have these symptoms for months

2) Have you ever felt a lump in your pelvis?

Ans: Adnexal mass increases the likelihood of cancer in postmenopausal women

Question 21

What is Dyspepsia?

Answer 21

Epigastric pain or burning that last for 1 month or more

Question 22

What symptoms are
associated Dyspepsia?

Answer 22

♦ Heartburn
♦ Nausea
♦ Regurgitation
♦ Bloating
♦ Belching

Note : Dyspepsia & Heartburn maybe indistinguishable

Question 23

For a Ovarian Cancer, what questions should I ask in my Past Medical Hx?

Answer 23

H/o HRT ?
H/o OCP use ?
H/o fertility medication use ?

Question 24

What lab investigations should be done in suspicion for Ovarian Cancer?

Answer 24

1st check CA-125 levels
- if more than 35 IU/mL order → TVUS or Abdominal U/S (if mass extends beyond pelvis or there are adhesions)

♦ Blood Tumor marker tests for:
postmenopausal women, check:
1) CA-125
2) Inhibin

for women under 40 check:
1) CA-125
2) Inhibin
3) Alpha fetoprotein (AFP)
4) Lactate dehydrogenase (LDH)
5) β hCG

Routine pre-operative labs:
♦ Baseline CBC
♦ LFTs
♦ U&E
♦ Creatinine
♦ ECG

Question 25

What are the types of Germ cell tumors?

Answer 25

1) Dysgerminoma

2) Teratoma

3) Endodermal sinus tumor

4) Choriocarcinoma

Question 26

What are the types of Teratoma

Answer 26

1) Immature

2) Mature

Question 27

What is another name for a mature teratoma

Answer 27

Dermoid cyst

Question 28

Which Teratoma is malignant?

Answer 28

Immature

Question 29

Which type of Teratoma is benign?

Answer 29

Dermoid cyst / Mature Teratoma

Question 30

What are the types of Epithelial Ovarian Cancer?

Answer 30

1) Serous carcinoma

2) Clear cell carcinoma

3) Endometrioid tumors

4) Mucinous tumors

5) Borderline tumors

6) Mixed cell tumors

Question 31

What is another name for a Borderline ovarian tumor?

Answer 31

Brenner ovarian tumor OR Transitional cell ovarian tumor

Question 32

What is the most common type of Epithelial Ovarian Cancer?

Answer 32

Serous carcinoma

Question 33

What is the 2nd most common type of Epithelial Ovarian Cancer?

Answer 33

Endometrioid tumors

Question 34

What is the least common type of Epithelial Ovarian Cancer?

Answer 34

1) Clear cell carcinoma

2) Mucinous tumors

3) Borderline tumors

4) Mixed cell tumors

Question 35

How do you estimate the risk of malignancy in ovarian masses?

Answer 35

1) Risk of Malignancy Index (RMI)

2) International Ovarian Tumor Analysis (IOTA) ultrasound rules

Question 36

When calculating the RMI score what formula is used?

Answer 36

RMI = CA-125 x U x M

CA-125 - units must be IU/mL