Ovarian Cancer

Question 1

Normal CA 125

Answer 1

<35 IU/ml

Question 2

How RMI is calculated

Answer 2

U x M x CA125

U= ultrasound
(0= if u/s scores 0, 1= u/s scores 1, 3= if u/s scores 2-5)
M= menopause (3)

Question 3

Characteristics that scores 1 in u/s scan for RMI

Answer 3

• Multilocular cysts
• evidence of solid areas
• evidence of metastasis
• presence of ascitis
• Bilateral leasions

Question 4

highest mortality of all gynaecological cancers,

Answer 4

5-6% ovarian cancer

Question 5

Epithelial ovarian cancer accounts for how much of all new cancers diagnosed in women

Answer 5

4%

Question 6

What is the most common gyn cancer in uk and worldwide

Answer 6

Uk: endometrial cancer
Worldwide: cervical cancer

Question 7

What is the most common cancer in females in uk and worldwide

Answer 7

Breast cancer

Question 8

Types of ovarian tumors

Answer 8

1. Epithelial cell:
   - serous
   - mucinous
   - brenners
   - endometrioid
2. Germ cell tumor
   -dysgerminoma
   -teratoma
   - choriocarcinoma
   - yolk sac
3. Sex cord stromal
   -granulosa cell
   - sertoli leydig
   - fibroma
   - thecoma

Question 9

How many of ovarian cysts are benign

Answer 9

90%

Question 10

Percentage of adnexal torsion in children

Answer 10

35%

Question 11

Ovarian cancer rank among women in uk

Answer 11

5th

Question 12

Age group of ovarian cancer

Answer 12

Under 30 years
Peak incidence 60-64 y

Question 13

Overall 5 y survival of ovarian cancer

Answer 13

35%

Question 14

Percent of malignant transformation of endometriosis

Answer 14

2.5% to cause ovarian cancer

Question 15

OCP reduces risk of ovarian cancer by what percent

Answer 15

For 5y: 25%
for 10y: 50%

Question 16

Risk of ovarian cancer by

Answer 16

Parity 30-60%
Lactation 40%
Tubal ligation 34%
Hysterectomy 34%

Question 17

5y mortality for BRCA gene mutation

Answer 17

Non carriers: 47%
BRCA1: 45%
BRCA2: 36%

Question 18

Lynch II Syn affects what group

Answer 18

Identified in families with strong history of colorectal, uterine, and ovarian cancer.

Question 19

Lynch ii syn lifetime risk of ovarian cancer

Answer 19

12%

Question 20

Management of LYNCH II SYN

Answer 20

Prophylactic Hysterectomy + BSO

All women with non mucinous ovarian cancer should be offered BRCA1 &2 testing

Question 21

Age of surgery in case of BRCA mutation

Answer 21

Not before 35 y

Question 22

Prior to prophylactic surgery of BRCA gene mutation what to do

Answer 22

2 month prior:
CA125+ USS to exclude cancer -> if +ve full staging laparotomy better than laparoscopic BSO

Question 23

After prophylactic laparoscopic BSO,
Risk of BC dec or inc
Risk of peritoneal cancer

Answer 23

Risk of BC dec 50%
Can develop peritoneal cancer 2%

Question 24

Ovarian tumors are of 2ry origin percentage

Answer 24

10%
Most commonly from endometrium

Question 25

Krukenberg tumor commnly from

Answer 25

Stomach or colon Breast, lung and pancreas

Question 26

In case of pathogenic variant MLH1 or MSH 2,6 what prophylactic surgery to be done

Answer 26

Hysterectomy + BSO TO REFUCE RISK OF ENDOMETRIAL CANCER

Question 27

Test before risk reducing surgery in case of mutations

Answer 27

Before BSO: TVS + CA125 Before hysterectomy: Endometrial biopsy

Question 28

What to do if woman refused Or to delay tisk reducing surgery

Answer 28

Every 4 month: Check CA125

Question 29

If woman had BSO before menopause + no BC

Answer 29

Give HRT till 51y

Question 30

If woman had BSO before menopause + no BC

Answer 30

Offer HRT until 51 y

Question 31

If woman had BSO before menopause + BC

Answer 31

Contact breast cancer care team

Question 32

HRT given in women with uterus and no uterus

Answer 32

Uterus: combined No uterus: E2 only

Question 33

Marker of dysgerminoma

Answer 33

LDH

Question 34

Marker and feature of epithelial cell tumor

Answer 34

CA125 Psammoma bodies

Question 35

Marker of mucinous tumor

Answer 35

CA125 CA19.9

Question 36

Marker of Brenner tumor

Answer 36

E2

Question 37

Marker of choriocarcinoma

Answer 37

HCG

Question 38

Marker of Yolk sac

Answer 38

AFP LDH

Question 39

Marker of granulosa cell tumor

Answer 39

Inhibin AMH