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Flashcards in Ovarian cancer Deck (20):
1

Natural Hx of serous ovarian cancer

Epithelial ovarian ca are thought to develop from ectopic fallopian tube/ovarian surface epithelium
May have non-specific symptoms before dissemination occurs
>75% patients diagnosed at stage III/IV
Death from ovarian ca usually results from progressive encasement of abdominal organs --> anorexia, vomiting, inanition

2

Risk factors of serous ovarian ca

BRCA1/2
no pregnancy
no breastfeeding
no OCP
no tubal ligation
nulliparity
infertility

3

Prevention of ovarian ca

maybe removing fallopian tubes
genetic testing, removing ovaries/tubes if +ve

4

Pre-cancerous stage of ovarian ca

Fallopian tube in situ

5

Spread of ovarian ca

exfoliation of cells throughout abdomen
Dougla's pouch (rectouterine), paracolic gutters, right hemi-diaphragm, liver, omentum
Lymph: periaortic, iliac, obturator, hypogastric

6

SSx of ovarian ca

VAGUE until stage 3/4
Early: vague abdominal pain/bloating
symptoms of mass pressing on bladder/rectum
dyspareunia
menstrual irregularities

Advanced: abdominal pain/swelling
ascites
constipation
nausea
dyspepsia
anoexia/early satiety
irregular menses, heavy vaginal bleeding

7

Dx of ovarian ca

Biopsy

8

Staging of ovarian ca

surgical
I: confined to ovary
II: confined to pelvis
III:confined to abdomen
IV: distant disease

9

Tx of ovarian ca

surgery + chemo

10

Prognosis of ovarian ca

Poor if stage III/IV (symptomatic stages)
age>70
residual after surgery
poor chemo response

11

Ovarian cancer oncogenesis

p53 gene alteration is the most frequent genetic aberration
Cyclin-dependent kinase inhibitors act as tumour suppressors by regulating transition between G1 --> S phase
p16 gene homozygous deletion in ~15%
Tumours from uterus, GI tract and breast = most common carcinomas to spread to ovary

12

Ovarian tumour histology

3 sets of cells that give rise to tumours:
1) ovarian epithelium
- mimic development of Mullerian tract
2) Germ cells: mimic embryogenesis
3) Ovarian stroma: arise from primitive stem cells
-"female" cells = granulosa/thecal
"male" cells = sertoli, leydig

13

Epidemiology of epithelial ovarian ca

8th most common in women
most lethal
majority are advanced stage, High grade serous cancer
incidence unchanged

14

Familial ovarian cancer

serous epithelial
Autosomal dominant
- BRCA1/2
- Lynch syndrome: associated with non-serous epithelial tumours
Consider "prophylactic" oophorectomy in carriers
IN women in BC with high grade serous ca: almost 20% will carry BRCA mutation

15

Benign germ cell tumor

cystic teratoma

16

Functional ovarian tumours

All benign:
follicular cyst
lutein cyst
theca-lutein cyst
luteoma of pregnancy
endometrioma
PCOS

17

Malignant germ cell tumours

dysgemimoma
immature teratoma
yolk sac tumour
embryonal
choriocarcinoma

18

Sex cord stromal ovarian tumours

benign fibroma
Granulosa-theca cell tumours
Sertoli-Leydig cell tumour

19

Serous epithelial ovarian tumours

75% of epithelial tumours
similar to fallopian tube epithelium
contain Psammoma bodies

20

Mucinous epithelial ovarian tumours

20% of epithelial tumours
resemble endocervical epithelium
can get enormous