OVARIAN CANCER (SB)

Question 1

What is the second most common malignancy of the lower female genital tract?

Answer 1

Ovarian cancer.

Question 2

What is the most frequent cause of death among gynecologic malignancies?

Answer 2

Ovarian cancer, due to late detection after metastatic spread.

Question 3

What are the three most common gynecologic cancers in the US?

Answer 3

Endometrial, ovarian, cervical.

Question 4

What are the three most common gynecologic cancers in the Philippines?

Answer 4

Cervical, ovarian, endometrial.

Question 5

Why is ovarian cancer often detected late?

Answer 5

Because symptoms only appear after metastatic spread.

Question 6

What is a major risk factor for endometrial cancer?

Answer 6

Anovulation.

Question 7

What is a major risk factor for ovarian cancer?

Answer 7

Ovulation.

Question 8

Why does regular ovulation increase the risk of ovarian cancer?

Answer 8

Because ovulation causes repeated injury to the ovary.

Question 9

What reproductive history increases the risk of ovarian cancer?

Answer 9

Nulliparity (non-gravida).

Question 10

What reproductive history increases the risk of endometrial cancer?

Answer 10

Gravida (pregnancy history).

Question 11

At what age does the risk of ovarian cancer markedly increase?

Answer 11

Beyond 50 years, with a peak at 70 years.

Question 12

What dietary factor increases the risk of ovarian cancer?

Answer 12

High animal fat diet (saturated fats).

Question 13

What dietary factor may reduce the risk of ovarian cancer?

Answer 13

Vegetable fiber.

Question 14

What type of cancer has the strongest familial link among gynecologic cancers?

Answer 14

Ovarian cancer.

Question 15

How does industrialization relate to ovarian cancer risk?

Answer 15

Higher incidence in industrialized countries.

Question 16

What fertility-related conditions increase the risk of ovarian cancer?

Answer 16

Infertility and ovulatory cycles.

Question 17

What genetic mutation is associated with ovarian cancer?

Answer 17

Overexpression of mutant p53 protein.

Question 18

What reproductive factors decrease the risk of ovarian cancer?

Answer 18

Breastfeeding, pregnancy, use of oral contraceptives (OCP), tubal ligation, hysterectomy with ovarian conservation.

Question 19

How do oral contraceptive pills (OCPs) reduce ovarian cancer risk?

Answer 19

They suppress ovulation by providing external steroids that compete with endogenous estrogen and progesterone.

Question 20

What is the typical clinical presentation of ovarian cancer?

Answer 20

Vague, non-specific symptoms that do not directly indicate ovarian origin.

Question 21

Why is ovarian cancer difficult to diagnose early?

Answer 21

The ovaries are located retroperitoneally, making symptoms nonspecific and often leading to late diagnosis.

Question 22

What are the common symptoms of ovarian cancer?

Answer 22

Increased abdominal size (ascites), bloating, urinary urgency, pelvic pain.

Question 23

What is the most common type of ovarian cancer?

Answer 23

Epithelial stromal tumors (65%).

Question 24

What is the second most common type of ovarian cancer, particularly in young women?

Answer 24

Germ cell tumors (20-25%).

Question 25

What type of ovarian tumor contains elements of all three embryonic layers?

Answer 25

Germ cell tumors.

Question 26

What type of ovarian tumor contains elements that mimic ovarian structures?

Answer 26

Sex cord-stromal tumors (6%).

Question 27

What are lipid (lipoid) cell tumors, and how common are they?

Answer 27

Extremely rare ovarian tumors that histologically resemble the adrenal glands (<0.1%).

Question 28

What are gonadoblastomas, and in whom do they occur?

Answer 28

Tumors containing germ cells and sex cord-stromal cells, occurring in individuals with dysgenetic gonads, especially those with a Y chromosome.

Question 29

What are two examples of soft tissue tumors that can occur in the ovary?

Answer 29

Hemangioma (blood vessels) and lipoma (subcutaneous tissue).

Question 30

What is an example of a highly virulent unclassified ovarian tumor?

Answer 30

Small cell carcinoma.

Question 31

What is a Krukenberg tumor?

Answer 31

A metastatic tumor to the ovary originating from the stomach or bowel.

Question 32

What are tumor-like conditions that cause ovarian enlargement but are not true neoplasms?

Answer 32

Extensive edema, endometrioma, pregnancy luteoma, follicular or luteal cyst.

Question 33

What is the main cause of ovarian malignancy in young women?

Answer 33

Germ cell tumors.

Question 34

Why do germ cell tumors commonly affect teenagers and young adults?

Answer 34

Because they originate from embryonic layers and are the most common ovarian malignancy in young women.

Question 35

What is the role of sex cord-stromal tumors in hormone secretion?

Answer 35

Some secrete sex steroid hormones, while others are hormonally inactive.

Question 36

Which ovarian tumor category includes the most frequent neoplasms?

Answer 36

Epithelial stromal tumors (common epithelial tumors).

Question 37

What differentiates metastatic ovarian tumors from primary ovarian tumors?

Answer 37

Metastatic tumors originate from other sites, such as the reproductive tract, stomach, or bowel.

Question 38

What is the most common type of epithelial ovarian tumor?

Answer 38

Serous epithelial ovarian tumor.

Question 39

What type of epithelial ovarian tumor consists of ciliated epithelial cells resembling the fallopian tubes?

Answer 39

Serous epithelial ovarian tumor.

Question 40

What is the benign form of serous ovarian tumors?

Answer 40

Serous cystadenomas.

Question 41

In which age group do serous ovarian carcinomas typically occur?

Answer 41

Women older than 40 years.

Question 42

What type of ovarian tumor consists of epithelial cells filled with mucin?

Answer 42

Mucinous epithelial ovarian tumor.

Question 43

What two structures can mucinous ovarian tumors resemble?

Answer 43

Endocervix and intestinal cells.

Question 44

What type of ovarian tumor resembles the endometrium and is associated with endometriosis?

Answer 44

Endometrioid ovarian tumor.

Question 45

In what age group do endometrioid ovarian tumors usually occur?

Answer 45

Women in their 40s and 50s.

Question 46

What type of ovarian tumor is associated with diethylstilbestrol (DES) exposure?

Answer 46

Clear cell ovarian tumor.

Question 47

What cellular feature characterizes clear cell ovarian tumors?

Answer 47

Hobnail cells with nuclei protruding into the glandular lumen.

Question 48

What ovarian tumor type resembles the transitional epithelium of the bladder?

Answer 48

Brenner (transitional) ovarian tumor.

Question 49

What is the primary imaging modality for evaluating adnexal masses?

Answer 49

Ultrasound (IOTA - International Ovarian Tumor Analysis).

Question 50

What ultrasound features help differentiate benign from malignant ovarian masses?

Answer 50

Simple (unilocular) vs. complex (multilocular with solid component), papillary projections, cystic wall/septa regularity, echogenicity, and color flow (neovascularization).

Question 51

What is the role of Doppler color-enhanced flow studies in adnexal mass evaluation?

Answer 51

To differentiate benign from malignant masses based on blood flow patterns.

Question 52

What tumor marker is used in ovarian cancer evaluation?

Answer 52

CA-125.

Question 53

Is CA-125 specific for ovarian cancer?

Answer 53

No, it is not specific but is sensitive; it can be elevated in conditions like endometriosis, pregnancy, appendicitis, and infections.

Question 54

What percentage of ovarian epithelial carcinomas express CA-125?

Answer 54

Approximately 80%.

Question 55

What is the CA-125 level generally considered increased?

Answer 55

>35 U/mL.

Question 56

Besides ovarian cancer, what cancers can elevate CA-125?

Answer 56

Primary peritoneal, fallopian tube, uterine, colon, breast, stomach, and liver cancers.

Question 57

What non-cancerous conditions can elevate CA-125?

Answer 57

Leiomyomata, endometriosis, pelvic infection, liver/heart/kidney failure, peritonitis, pancreatitis, pregnancy, and mild menstrual cycle changes.

Question 58

What is the normal size of an ovary?

Answer 58

1.5 x 2.5 x 4 cm.

Question 59

What is the approximate size of a normal postmenopausal ovary?

Answer 59

1.5 to 2 cm in diameter.

Question 60

At what ovarian size in postmenopausal women is surgery indicated?

Answer 60

>3 cm.

Question 61

What ovarian size is considered abnormal in the reproductive age group?

Answer 61

>5 cm.

Question 62

What ultrasound features suggest a malignant ovarian mass?

Answer 62

Solid component, echogenic areas, septations, and color Doppler neovascularization.

Question 63

What are the primary lymph node routes for ovarian cancer spread?

Answer 63

Pelvic and paraaortic lymph nodes.

Question 64

What are the most frequent sites of ovarian cancer relapse?

Answer 64

Pelvic and aortic lymph nodes (39%), peritoneum (33%), bowel (28%), and pelvis (22%).

Question 65

According to FIGO staging, what defines Stage 1A ovarian cancer?

Answer 65

Cancer is confined to one ovary with an intact capsule.

Question 66

According to FIGO staging, what defines Stage 1B ovarian cancer?

Answer 66

Cancer is present in both ovaries with intact capsules.

Question 67

According to FIGO staging, what defines Stage 1C ovarian cancer?

Answer 67

Cancer has ruptured the ovarian capsule.

Question 68

What are the major prognostic factors for ovarian cancer?

Answer 68

Tumor stage, tumor grade, and residual tumor after primary resection.

Question 69

How does tumor stage affect ovarian cancer prognosis?

Answer 69

Higher stage = poorer prognosis.

Question 70

How does tumor grade affect ovarian cancer prognosis?

Answer 70

Poorer grade = poorer prognosis.

Question 71

What is the major determinant of ovarian cancer prognosis?

Answer 71

Tumor grade.

Question 72

What is the primary goal of cytoreductive surgery in advanced ovarian cancer?

Answer 72

Debulking the tumor.

Question 73

What are the objectives of ovarian cancer surgery (hysterectomy - TAHBSO)?

Answer 73

Diagnosis, fertility preservation (if unilateral), surgical staging (early stage), and cytoreduction (advanced stage).

Question 74

What is the standard chemotherapy regimen for ovarian cancer?

Answer 74

BEP [bleomycin, etoposide, cisplatin] regimen.

Question 75

Which ovarian tumor type is highly radiosensitive?

Answer 75

Pure dysgerminoma.