ovarian cancer

Question 1

a mutation in which genes increase the risk of ovarian cancer?

Answer 1

BRCA1 (40%)

BRCA2 (18%)

Question 2

what are some risk factors for ovarian cancer

Answer 2

BRCA1/2 mutations
lynch syndrome
old age >80 years
many ovulations (early menarche, late menopause, nulliparity)

Question 3

symptoms

Answer 3

like IBS
abdominal distension and bloating
abdominal and pelvic pain
urinary symptoms e.g. Urgency
early satiety
diarrhoea

Question 4

investigations for ovarian cancer?

Answer 4

Ca 125
transvaginal pelvic USS
CT scan

Question 5

diagnosis of ovarian cancer?

Answer 5

diagnostic laparotomy

Question 6

how is RMI calculated?

Answer 6

menopause status x USS features x Ca125

Question 7

what impact does number of ovulations have on ovarian cancer risk?

Answer 7

more ovulations = high risk

Question 8

the four main types of ovarian tumours?

Answer 8

epithelial-derived (60%)
germ cell tumour (20%)
sex chord/stromal (5%)
mets (2%)

Question 9

what are krukenberg tumours?

Answer 9

mucin-secreting signet-ring cell adenocarcinomas

arise from the GI tract

Question 10

what is the most common malignant ovarian tumour?

Answer 10

high grades serous carcinoma (epithelial derived)

Question 11

what is the pathogenesis for high grade serous cell tumours?

Answer 11

p53 mutation - serous tubal intraepithelial carcinoma (STIC) - HGSC

Question 12

what are walthard cell nests and which epithelial-derived tumour contains them?

Answer 12

transitional cell (brenner) tumour
clusters of urothelial metaplasia in the ovary

Question 13

what is the difference between a mature and immature teratoma? (both are germ cell tumours)

Answer 13

mature teratoma-benign dermoid cyst

immature teratoma-malignant, contains embryonic tissue

Question 14

a complete molar pregnancy is associated with which type of malignant germ cell tumour?

Answer 14

choriocarcinoma

secretes HCG - haematemesis and thyrotoxicosis

Question 15

what is the most common germ cell ovarian tumour?

Answer 15

dysgerminoma
secretes HCG &LDH
similar to testicular seminoma
assoc. with turner syndrome

Question 16

which germ cell tumour that affects children secretes AFP and contains schiller duval bodies?

Answer 16

yolk sac tumour

Question 17

what are the three sex chord/stromal tumours?

Answer 17

fibroma
granulosa cell tumour
sertoli -eydig tumour

Question 18

which sex chord/stromal tumour secretes oestrogen?

Answer 18

granulosa cell tumour

can present as precocious puberty or endometrial hyperplasia

Question 19

which sex chord/stromal tumour secreted androgens and has a masculinizing effect?

Answer 19

sertoli-leydig cell tumour

Question 20

features of meig syndrome?

Answer 20

pleural effusion
ascites (transudate)
fibroma (benign ovarian tumour)

Question 21

what other conditions can Ca125 be raised in?

Answer 21

Endometriosis, fibroids, pregnancy, menstruation, benign ovarian cysts, other cancers, pleural effusion

Question 22

a three month history of new onset IBS symptoms in a post-menopausal woman should be investigated for what?

Answer 22

ovarian cancer

Question 23

what five USS features are assessed in RMI?

Answer 23

multiloculated
solid areas
bilateral
mets 
ascites