Ovarian Cancer

Question 1

What are the 4 main types of cancer in the ovary?

Answer 1

Surface epithelial tumours
Germ cell tumours
Sex cord/stromal tumours
Secondary/metastatic tumours

Question 2

What are the 5 types of surface epithelial tumours in the ovary?

Answer 2

Serous carcinoma
Mucinous tumours
Clear cell tumours
Endometrioid tumours
Transitional cell tumours

Question 3

What are the 7 types of germ cell tumour in the ovary?

Answer 3

Dermoid cyst (mature cystic teratoma)
Immature teratoma
Dysgerminoma
Embryonal carcinoma
Yolk sac tumour
Choriocarcinoma
Mixed tumours

Question 4

What are the 6 types of sex cord/stromal tumours in the ovary?

Answer 4

Fibroma
Thecoma
Granulosa cell tumour
Sertoli-Leydig cell tumours
Leydig cell tumours
Sex cord tumour with annular tubules

Question 5

What are 4 common sites of origin for metastases in the ovary?

Answer 5

Lymphoma
Gastric cancer
Colon cancer
Breast cancer

Question 6

Which type of surface epithelial tumours of the ovary is NEVER benign?

Answer 6

Endometrioid tumours

Question 7

What are the features of benign serous carcinomas? (4)

What type of ovarian tumour are they?

Answer 7

Surface epithelial tumour

FEATURES:
Bilateral in 20%
Always 1+cm, up to 30cm
Epithelium: single layer of cuboidal/tubal epithelium
Contains solid fibrous areas

Question 8

What are the 3 subtypes of serous carcinomas?

How common are they?

Answer 8

Benign (50%)
Borderline (20%)
Malignant (30%)

Question 9

What are the features of borderline serous carcinomas? (3)

What features are seen on histology? (4)

What type of ovarian tumour are they?

Answer 9

Surface epithelial tumour

FEATURES:
Bilateral in 40%
Papillary projections
Extra-ovarian implants (invasive or non-invasive) - NOT NECESSARILY MALIGNANT

HISTOLOGY:
Mild-moderate cell atypia
Nuclear crowding
Nuclear stratification
Mitotic figures

Question 10

What are the 2 types of malignant serous carcinoma?

Which mutations are involved in each?

Answer 10

Type 1 - low grade
Mutations: K-RAS, B-RAF

Type 2 - high grade
Mutations: TP53, BRCA

Question 11

Describe the staging of malignant serous carcinoma.

Answer 11

Stage 1 - ovary only

Stage 2 - metastases confined to pelvis

Stage 3 - metastases spread outside of pelvis OR in lymph nodes

Stage 4 - distant metastases

Question 12

What are the 3 subtypes of mucinous ovarian tumours?

How common is each?

Answer 12

Benign (80%)
Borderline (15%)
Malignant (5%)

Question 13

What are the features of benign mucinous ovarian tumours? (5)

What sort of tumours are they?

Answer 13

Surface epithelial tumours

FEATURES:
Large lakes of mucous
Often large (30+cm)
Rarely bilateral
Usually multifocal
Epithelium: endocervical or GI epithelium (or mixed)

Question 14

What are the histological features of borderline mucinous ovarian tumours? (4)

What sort of tumours are they?

Answer 14

Surface epithelial tumours

HISTOLOGY:
Mild-moderate cellular atypia
Nuclear crowding
Nuclear stratification
Mitotic features

Question 15

What are the 2 types of endometrioid tumours?

How common is each?

Answer 15

Borderline (10%)

Malignant (90%)

Question 16

What conditions are associated with endometrioid tumours?

What sort of tumours are these?

Answer 16

Surface epithelial tumours

ASSOCIATED WITH:
Endometriosis (40%)
Endometrial adenocarcinoma (20%)

Question 17

What are the 2 types of clear cell tumour in the ovary?

Answer 17

Clear cell carcinoma

Carcinosarcoma (MMMT)

Question 18

What are the 3 types of transitional cell tumour in the ovary?

Answer 18

Benign (Brenner tumour)
Borderline
Malignant

Question 19

What is the main serum biomarker associated with ovarian cancer?

Answer 19

Ca125