Ovarian Cancer

Question 1

adnexa

Answer 1

uterine appendages; Fallopian tubes/ovaries/supporting tissue

Question 2

5-year survival of ‘distant’ stage ovarian cancer

Answer 2

28%

Question 3

most prevalent stage of ovarian cancer

Answer 3

‘distant’ stage (60%); 5 year survival = 28%

Question 4

ovarian cancer is staged clinically or surgically?

Answer 4

surgically

Question 5

ovarian cancer that has spread to upper abdomen or regional LNs is stage:

Answer 5

stage III (most common - 60%)

Question 6

ovarian cancer that is limited to pelvis is stage:

Answer 6

II

Question 7

ovarian cancer found in liver or lungs is stage:

Answer 7

IV

Question 8

median age of presentation of ovarian cancer

Answer 8

65 y.o.

Question 9

most common type of ovarian cancer:

• germ cell
• epithelial ovarian cancer (EOC) or
• sex-cord stromal

Answer 9

EOC (80%); germ cell (15%); sex-cord stromal (5%)

Question 10

serous, mucinous, endometroid, clear cell, transitional cell, undifferentiated are all types of ____ ovarian cancer and are derived from:

Answer 10

epithelial ovarian cancer (EOC); ovarian surface mesothelial cells

Question 11

tend to occur in 6th decade of life

Answer 11

EOC

Question 12

80% of malignant ovarian tumors are of what type?

Answer 12

epithelial ovarian cancer (EOC)

Question 13

tend to occur in 2nd and 3rd decade of life

Answer 13

germ cell tumors

Question 14

type of ovarian cancer with better prognosis

Answer 14

germ cell tumors

Question 15

dysgerminoma, endometrial sinus tumor, teratomas, embryonal carcinoma, choriocarcinoma, mixed are all types of ____ ovarian cancer

Answer 15

germ cell tumors

Question 16

type of ovarian cancer that often produces biological markers

Answer 16

germ cell tumors

Question 17

type of germ cell tumor that produces LDH

Answer 17

dysgerminoma

Question 18

tumors of younger women

Answer 18

sex cord stromal tumors and germ cell tumors

Question 19

granulosa cell tumor

Answer 19

most common tumor of sex cord origin (1-2% of all ovarian neoplasms)

Question 20

associated with hyperestrogenism; may cause precocious puberty (girls), adenomatous hyperplasia and vaginal bleeding in postmenopausal women

Answer 20

granulosa cell tumor (sex cord-stromal origin)

Question 21

Risk factors for ovarian cancers

Answer 21

family history, age (older), endometriosis, nulliparity, early menarche/late menopause, late childbirth, environmental factors

Question 22

risk reduction for ovarian cancer

Answer 22

oral contraceptive pills, multiparity, oophorectomy, tubal ligation/salpingectomy (from FT?), breastfeeding

Question 23

non-specific and vague symptoms of ovarian cancer include:

Answer 23

-increase in abdominal girth, bloating, fatigue, abdominal pain, back pain, intercourse pain, early satiety, indigestion, constipation, unexplained weight loss, urinary frequency or incontinence

Question 24

benign gynecologic differential for ovarian cancer symptoms:

Answer 24

functional cyst, leiomyomata, endometrioma, ectopic, teratoma, cystadenoma, TOA (tubo-ovarian abscess)

Question 25

malignant gynecologic differential for ovarian cancer symptoms:

Answer 25

EOC, germ cell, sex-cord stromal

Question 26

non-gynecologic differential for ovarian cancer symptoms:

Answer 26

- benign: diverticular or appendiceal abscess, nerve sheat tumor, pelvic kidney; - malignant: colon, breast, gastric cancer

Question 27

account for 10% epithelial ovarian cancers (EOC)

Answer 27

hereditary ovarian cancer

Question 28

HNPCC associated with ovarian cancer

Answer 28

Lynch II

Question 29

HBOC genes

Answer 29

BRCA1, BRCA2

Question 30

40% ovarian cancer risk if this gene is mutated

Answer 30

BRCA1 chromosome 17; (10-20% if BRCA 2, chromosome 13)

Question 31

10-15% ovarian cancer risk if this gene is mutated

Answer 31

HNPCC (lynch 2) -- autosomoal dominant

Question 32

``` Screening for ovarian cancer can include: A. physical exam B. pap smear C. TVUS D. biomarkers: CA125, ROMA, He4, OVA-1 E. All of above ```

Answer 32

all EXCEPT pap smear

Question 33

Sister Mary Joseph's Nodule indicates

Answer 33

stage IV ovarian cancer; specific nodule found at umbilicus

Question 34

mobile, cystic, unilateral, smooth lymph node indicates ____ process

Answer 34

benign

Question 35

fixed, solid or firm, bilateral, nodular indicates ___ process

Answer 35

malignant

Question 36

TVUS findings of no blood flow to unilateral mass with septations

Answer 36

benign

Question 37

TVUS findings of solid or cystic and solid, strong blood flow, multiple septations > 3 mm in size, bilateral and ascites suggests ___ process

Answer 37

malignant

Question 38

TVUS findings of 9 cm simple cyst with calcifications suggests ____ process

Answer 38

benign

Question 39

T or F: CA125 value of 100 u/mL in premenopausal patient indicates no tumors

Answer 39

could be true or false: may show normal value in 50-70% of stage I tumors and in 20-25% of advanced tumors. Abnormal values are thought to be >200 u/mL premenopausal and > 35 postmenopausal

Question 40

T or F: simultaneous screening with CA125 and TVUS compared with usual care reduces ovarian cancer mortality

Answer 40

FALSE: did not reduce ovarian cancer mortality

Question 41

characteristics of ultrasound findings of benign cyst

Answer 41

unilocular, thin-walled

Question 42

ACOG (American Congress of OB/GYN) referral guidelines for pelvic mass in postmenopausal include:

Answer 42

postmenopausal women with suspicious pelvic mass that contains at least one: -CA125 >35; -fixed or nodular pelvic mass; -FHx of ovarian or breast cancer; -distant mets; -ascites

Question 43

ACOG referral guidelines for pelvic mass in premenopausal include:

Answer 43

-CA125>200; -ascites; -evidence of mets; -FHx of breast or ovarian cancer

Question 44

T or F: 30 y.o. female with suspicious pelvic mass and CA125 of 40 should be referred

Answer 44

False: if was postmenopausal, then yes. (premenopausal needs CA125 >200)

Question 45

T or F: 1 example of therapy plan for ovarian cancer would be giving platinum agent and taxane only.

Answer 45

False: usually combo of surgery and chemotherapy (platinum agent and taxane)

Question 46

treatment for ovarian cancer:

Answer 46

combo of surgery ( staging, debulking, interval debulking) & chemo (adjuvant, neoadjuvant, taxane adn platinum agent)

Question 47

CA125 tumor marker has many false negatives or false positives?

Answer 47

false positives