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Year 5: Gynaecology > Ovarian cancer (need differentials) > Flashcards

Ovarian cancer (need differentials) Flashcards

(52 cards)

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1
Q

How common is ovarian cancer?

A

6th most common cancer in woman

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2
Q

What is the peak incidence of ovarian cancer?

A

75-84 years

Starts to arise in patients >60 years

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3
Q

What are the 4 main subtypes of ovarian cancer?

A

Subtypes based on cell-type origin

Epithelial

  • Endometriod
  • Clear cell
  • Serous cystadenoma
  • Mucinous cystadenoma

Germ cell

  • Choriocarcinoma
  • Dysgerminoma
  • Teratoma

Sex chord stroma

  • Fibroma
  • Granulosa- Theca cell tumour
  • Sertoli-Leydig cell tumour

Malignant
* Krukenburg tumour

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4
Q

What is the most common subtype of ovarian cancer?

A

Epithelial ovarian cancer (90%)

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5
Q

What are the main subtypes of epithelial ovarian tumours?

A

Endometriod (Malignant)

Clear cell (Malignant)

Serous cystadenoma (Benign)

Mucinous cystadenoma (Benign)

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6
Q

Which 2 subtypes of epithelial ovarian tumours are malignant?

A

Endometriod

Clear cell

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7
Q

What are the main histological/lab features of endometrioid carcinoma?

A

Tubular glands

Raised Ca125

Mimics endometrium (form tubular glands ), therefore endometriosis is a risk factor.

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8
Q

What are the main histological/lab features of clear cell carcinoma?

A

Presence of clear cells

Clear cytoplsam

Hobnail appearance

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9
Q

What is the most common benign epithelial ovarian tumour?

A

Serous cystadenoma

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10
Q

What are the main histological/lab features of serous cystadenoma?

A

Psamomma bodies

Columnar epithelium

Mimics tubal epithelium i.e. columnar epithelium

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11
Q

What are the main histological/lab features of mucinous cystadenoma?

A

Mucin secreting cells

K-ras mutation (75%)

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12
Q

Mucinous cystadenoma is associated with which rare complication?

A

Pseudomyxoma peritonei

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13
Q

Define pseudomyxoma peritonei

A

Intraperitoneal accumulation of mucinous ascites due to mucin-producing neoplasm in the appendix

Appendix tumour → metastasis to abdomen, peritoneum and ovaries → pseudomyxoma peritonei

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14
Q

Pseudomyxoma peritonei is associated with which ovarian tumour

A

Mucinous cystadenoma

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15
Q

What are the main subtypes of germ-cell ovarian tumours?

A

Dysgerminoma
* Benign in adults
* Malignant in young women

Choriocarcinoma (malignant)

Teratoma
* Mature (Benign)
* Immature (Malignant)

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16
Q

Dysgermimoa is mostly benign (95%). In which individuals is it more likely to be malignant?

A

Mostly malignant in children

(Most common ovarian malignancy in young woman)

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17
Q

What is the most common ovarian malignancy in young woman?

A

Dysgerminoma (female counterpart to testicular seminoma)

Rare overall however

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18
Q

What is the most common benign tumour in young woman?

A

Teratoma (Mature teratoma/ dermoid cyst)

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19
Q

Mature teratoma are alternatively known as?

A

Dermoid cyst

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20
Q

What are the main histological features of mature teratoma/dermoid cyst?

A

Cystic

Differentiation into mature tisues:
* Hair
* Teeth
* Bone
* Cartillage

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21
Q

Which type of teratoma is malignant?

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A

Immature teratoma

22
Q

What are the main histological features of immature teratoma?

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A

Solid

Contains Immature, embyronal tissue

Secretes AFP

23
Q

Choriocarcinoma secretes which hormone

Study These Flashcards
A

hCG (human chorionic gonadotropin)

24
Q

What are the 3 main types of sex-chord stroma?

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A

Fibroma

Granulosa-Theca cell tumour

Sertoli-Leydig cell tumour

25
Fibroma are associated with what syndrome?
Meig's syndrome
26
What are the main features of Meig's syndrome?
Triad of: Fibroma Ascites R-sided pleural effusion
27
What are the histological features of Granulosa-Theca cell tumour?
Produces **E2** **Call-Exner bodies** ## Footnote Suspect if oestrogenic effects – irregular menstrual cycles, breast enlargement, endometrial/breast cancer
28
What are the main histological features of Sertoli-Leydig cell tumour?
Excretes androgens ## Footnote Suspect if presentation of virilisation
29
Name the ovarian tumour which can arise secondary to gastric/colonic cancer metastases
Krukenberg tumour
30
What is the key histological feature of Krukenberg tumour
**Mucin-secreting signet ring cells**
31
What are the main risk factors for ovarian cancer?
Advanced age (>75) Smoking Increased number of ovulations: * Early menarche * Late menopause Obesity HRT Genetic predisposition: * BRCA 1 and 2 * Lynch syndrome FHx ovarian cancer
32
Genetic mutations in which genes are associated with ovarian cancer?
BRCA1 BRCA2
33
What are **protective** factors against ovarian cancer?
Childbearing (parity) Breastfeeding Early menopause COCP
34
What are the main clinical features of ovarian cancer?
_Demographic_: Age >60 (75-84) _Initial presentation_: Abdominal discomfort Bloating Early satiety Urinary frequency/change in bowel habits _Late presentation_ Ascites Pain * Pelvic * Back * Abdominal Palpable abdominal/pelvic mass ## Footnote Initial symptoms typically presents late in disease onset
35
What investigations should be conducted in patients with suspected ovarian cancer?
**_Bedside_**: Abdominal examination * Check for abdominal mass or ascites **_Bloods_**: CA-125 AFP hCG **_Imaging_**: Transvaginal US: Indicated with elevated CA-125 (_>_ 35 IU/ml) Tissue biopsy: If abnormal US findings CT chest/pelvis/abdomen: For staging
36
When is an immediate 2-week referral to gynaecological cancer indicated in patients with suspected ovarian cancer?
Presence of ascites on abdominal examination Presence of abdominal/pelvic mass (if not known to have fibroids)
37
Ovarian cancer is non-specific, when is CA-125 indicated?
Woman > 50 AND Persistent symptoms (Symptoms occuring _>_12 times per month) ## Footnote N.B. Next order of investigation if pelvic/abdomen examination normal
38
What lab findings are indicative of ovarian cancer?
Elevated Ca-125 (_>_ 35 IU/ml) Elevated AFP: Germ-cell tumours hCG: Germ-cell tumours
39
What findings are indicative of a germ-cell tumour?
Elevated AFP (alpha-fetoprotein) Elevated hCG
40
When is an urgent transvaginal US indicated?
If Ca125 > 35
41
What scoring system is used to estimate the likelihood of a malignant cyst?
Risk of Malignancy Index (RMI)
42
How is RMI score calculated?
**RMI = U x M x Ca-125** **U = Ultrasound (points 0-3)** * 1 ultrasound feature = 1 point * 2-5 ultrasound features = 3 points **M = Menopause** * 1 point for premenopausal. * 3 points for post-menopausal **Ca125**
43
What is the RMI cutoff score for specialist referral?
250 or more
44
What is the 2-week wait referral criteria for ovarian cancer?
Examination shows evidence of ascites and/or pelvic abdominal mass OR US findings suggestive of ovarian malignancy
45
What staging system is used for ovarian cancer?
FIGO
46
What procedures are performed to enable FIGO staging of ovarian cancer?
Surgical staging which typically involves: * Abdominal hysterectomy * Bilateral salpingo-oophorectomy * Appendectomy (if appendix looks abnormal) * Omenectomy * Pelvic and para-aortic lymph node dissections * Peritoneal biopsies Genetic testing of obtained samples (e.g. BRCA1/BRCA2)
47
What is considered stage 1?
ONLY in ovaries
48
What is considered stage 2?
Spread to pelvis
49
What is considered stage 3?
Spread to abdomen and/or regional node lymphadenopathy
50
What is considered stage 4?
Metastasis outside abdominal cavity (Distant met)
51
What is the management plan for patients with ovarian cancer?
**_Surgical_**: Early disease: Removal of uterus, ovaries and fallopian tube + omentectomy (typical done during surgical staging) followed by monitoring Advance disease (II, III, IV) : as above + further debulking (aka cytoreduction) **_Medical_**: Adjuvant chemotherapy * Typically platinum-based chemotherapy
52
What is debulking (cytoreduction)?
Attempted surgical removal off all visbile tumour deposits from abdomen, pelvis, and retroperitoneum

Year 5: Gynaecology (77 decks)

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