Ovarian cancer

Question 1

How often are they benign?

Answer 1

80%

Question 2

How common? Deaths?

Answer 2

2 (after endometrial cancer?)

But #1 KILLER (wrt gynecologic cancer). Accounts for 50% of deaths from female genital tract cancer. This is cuz there aren’t screening tools.

Question 3

5 year survival

Answer 3

25-45%

Question 4

How often are they epithelial tumors?

Answer 4

90%

Question 5

Which is caused from GI mets?

Answer 5

Krukenberg

Question 6

Spread?

Answer 6

Direct exfoliation

Lymphatic
Hematogneous (brain/lung)

Question 7

Symptoms of advanced disease?

Answer 7

Ascites, bowel encaseemnt causing intermittent bowel obstruction aka “carcinomatous ileus”

Question 8

Cause?

Answer 8

Unclear but believed to be after chronic uninterrupted ovulation (this disrupts the epithelium and activates cell repair mechs)

Question 9

Genetic risk?

Answer 9

BRCA1 85% breast cancer risk, 30-50% ovarian cancer risk

HNPCC

Cancer tends to occur 10 years earlier than these people (so like 50s or even 40s)

Question 10

Average age of diagnosis?

Answer 10

61 (same as endometrial) with 2/3 being over age 55.

Question 11

Risk factors

Answer 11

Familial ovarian cancer syndrome hx > familial hx of it
Breast cancer
Uninterrupted ovulation
Increasing age
Talcum powder
Obesity BMI >30

Question 12

Protective factors

Answer 12

OCPs, breastfeeding, multiparity, chronic anovulation, infertility, early menarche, nulliparity, late menopause

TUBAL LIGATION AND HYSTERECTOMY

Question 13

Physical exam

Answer 13

Possibly solid, fixed, irregular pelvic mass

Mets to umbilicus aka Sister Mary Joseph nodule

Ascites

Question 14

Diagnosis

Answer 14

Pelvic ultrasound

Barium enema and IVP help r/o GI and genitourinary causes of sx.

Need to look for mets as soon as you make diagnosis

MONITORING WITH CA-125, AFP, LDH, hCG

Remember that CA-125 is actually very nonspecific and can be seen in lots of cancers or benign conditions, like pancreatitis, cirrhosis, endometriosis, fibroids, normal/ectopic pregnancy, PID, peritonitis

Question 15

Staging

Answer 15

SURGICAL

TAHBSO, omentectomy, peritoneal washings, pap smear of diaphragm, pelvic and paraaortic LN sampling

Question 16

Treatment for malignant epithelial tumors?

Answer 16

Surgery + chemo

Question 17

What chemo agents for epithelial?

Answer 17

Carboplatin and paclitaxel

Patients with optimal debunking given intraperitoneal cisplatin and paclitaxel chemo along with IV chemo

Question 18

For evaluating success of treatment of epithelial?

Answer 18

CA-125 and CAT scan imaging

Question 19

How often do epithelial recur?

Answer 19

Frequently. Give chemo.

Question 20

5 year survival

Answer 20

20% for epithelial (80-95% for stage 1, 40-70% for stage II, 30% for stage III…)

Question 21

What are the epithelial cancers?

Answer 21

#1 is serous cystadenocarcinoma
Mucinous
Endometrioid
Clear cell
Brenner
Undifferentiated 

CAUCASIAN

Question 22

Describe serous tumors

Answer 22

large, cystic, bilateral 65% of the time

Question 23

Germ cell tumors? Age group?

Answer 23

0-25 yo. (younger more likely to be malignant)

Also more common in blacks and Asians.

Benign cystic mature teratoma aka dermoid cyst is MC. 95% are benign

Malignant:

• Dysgerminomas 50%
• Immature teratomas 20%
• Endodermal sinus (yolk sac) 20%
• Uncommon: Embroynal carcinoma, nongestational choriocarcinoma (composed of placenta tissue), mixed germ cell

Question 24

In contrast to epithelial tumors, germ cell tumors:

Answer 24

Grow rapidly, are limited to one ovary, and are stage I at diagnosis, considered quite curable

Question 25

Marker for dysgerminoma

Answer 25

LDH

Question 26

Marker for endodermal sinus

Answer 26

AFP

Question 27

Marker for embroynal

Answer 27

AFP and hCG

Question 28

Marker for choriocarcinoma

Answer 28

HCG

Question 29

Clinical manifestations of germ cell tumors

Answer 29

Most women have abdominal pain. | Grow rapidly so tend to hemorrhage and necrosis, so acute pelvic pain

Question 30

Treatment for germ cell tumors

Answer 30

Unilateral salpingo-oophorectomy (if fertility is desired) Otherwise, TAHBSO with surgical staging. Everything but stage Ia dysgerminomas and immature teratomas req multi agent chemo: BEP- bleomycin, etoposide, cisplatin. Very curable

Question 31

Sex cord stromal tumors

Answer 31

Low grade and can occur at any age. Unilateral, rarely recur. Ages 40-70. Since some are functional and produce estrogen, may have concomitant endometrial hyperplasia (25-50%) or carcinoma (5%). Granulosa-theca (70%) Sertoli-Leydig Ovarian fibroma

Question 32

Granulosa-theca characteristics

Answer 32

``` Resemble fetal ovaries Produce lots of estrogen Coffee-bean nuclei "Call-exner bodies" Produce estradiol and inhibinA/B (get an endometrial sampling!) ```

Question 33

Sertoli-Leydig characteristics

Answer 33

Resemble fetal testes | Produce testosterone, androgens (virilization)

Question 34

Fibroma characteristics

Answer 34

Mature fibroblasts, NOT FUNCTIONING (unlike the others) | Ascities, right hydrothorax, mass = Meigs syndrome

Question 35

Treatment of sex cord stromal tumors?

Answer 35

Unilateral salpingoophorectomy. | Chemo and radiation have no regular role!

Question 36

Fallopian tube cancer

Answer 36

Can occur at any age. Progression similar to ovarian cancer w/ peritoneal spread and ascites. Most are adenocarcinomas 10% bilateral (often the result of mets) Very very rare

Question 37

Epidemiology of fallopian tube cancer

Answer 37

Caucasian, 55-60 yo. BRCA1 and 2, nulliparity, infertility

Question 38

Clinical manifestations of fallopian tube cancer

Answer 38

Asymptomatic usually Latzko's triad: profuse watery discharge, pelvic pain, pelvic mass Hydrops tubae profluens (intermittent hydrosalpinx)

Question 39

Diagnosis of fallopian tube cancer, staging, treatment

Answer 39

Often incidental finding during surgery. CA-125 may be elevated. Surgical staging. Same treatment as ovarian Chemo w/ carboplatin and paclitaxel. Prognosis slightly better than epithelial ovarian cancer.

Question 40

What is a dermoid cyst?

Answer 40

Benign cystic teratoma

Question 41

How often are dermoid cysts bilateral?

Answer 41

10%