Ovarian Masses Flashcards
(111 cards)
1
Q
Symptoms: Acute pain in a reproductive age patient
A
Hemorrhagic cyst, ruptured cyst, ectopic pregnancy, torsion
2
Q
Symptoms: Unilateral, intermittent, acutely worsening, vomiting in reproductive age patient
A
Ovarian Torsion
3
Q
Symptoms: Indolent with fevers, chills, discharge in reproductive age patient
A
TOA
4
Q
Dysmenorrhea or pain with intercourse
A
Endometrioma
5
Q
Ultrasound findings suggestive of malignancy
A
> 10 cm, solid components, septations, nodules, pappilary projections, doppler flow, free fluid
6
Q
What is the size cut off for a cyst that can be observed?
A
10 cm
7
Q
Criteria for GYN onc referral in a premenopausal patient
A
CA 125 > 200, Ascites, Evidence of abdominal or distant metastases
8
Q
Criteria for GYN onc referral in a post menopausal patient
A
CA125 >20, Ascites, Evidence of abdominal or distant metastases, nodular or fixed mass, Size > 10 cm
9
Q
CA 125 is specific for what type of ovarian cancer?
A
Epithelial
10
Q
In what proportion of patients with epithelial ovarian cancers is CA 125 elevated?
A
80%
11
Q
What is the recurrence rate of a simple cyst following aspiration?
A
40%
12
Q
What are common diagnosis of adnexal masses during pregnancy?
A
Mature teratoma, corpus luteum
13
Q
What is the most common ovarian malignancy during pregnancy?
A
Dysgerminoma
14
Q
What is the risk of cancer in patient with an adnexal mass diagnosed during pregnancy?
A
1-7%
15
Q
When does CA 125 peak during pregnancy
A
1st trimester
16
Q
When is surgery for ovarian mass indicated in pregnancy?
A
indicated if symptomatic or concern for cancer based on imaging
17
Q
How and when should you perform surgery for a patient with an adnexal mass diagnosed in pregnancy?
A
laparoscopic OR open approach in the second trimester
18
Q
Ovarian cancer is the ____ most common gyn cancer
A
second
19
Q
What is a woman’s baseline risk of ovarian cancer
A
1/70 lifetime risk
20
Q
True or False: Ovarian cancer is the leading cause of death of gyn cancers
A
True
21
Q
What are the main risk factors for ovarian cancer?
A
Older age, nulliparity, infertility, early menarche, late menopause
22
Q
What are protective factors for ovarian cancer?
A
OCP use, Multiparity, lactation, tubal ligation
23
Q
By how much does OCP use decrease ovarian cancer risk?
A
50% decrease
24
Q
How many years do you need to use OCPs to get maximum benefit from an ovarian cancer risk standpoint?
A
5 years
25
What are the anatomic origin of high and low grade serous ovarian cancer?
Ovarian surface and fallopian tube epithelium
26
What is the anatomic origin of clear cell carcinoma?
endometrium
27
What is the anatomic origin of endometriod carcinoma?
endometrium
28
What percent reduction occurs with salpingectomy at time of hysterectomy in normal risk patients?
18%
29
What percent reduction occurs with tubal ligation?
10%
30
What percent of ovarian cancer is caused by hereditary syndromes?
5 - 10%
31
BRCA1 accounts for what percent of hereditary ovarian cancer?
70%
32
BRCA2 accounts for what percent of hereditary ovarian cancer?
20%
33
BRCA1 is associated with what lifetime risk of ovarian cancer?
40% lifetime risk
34
BRCA1 is associated with what lifetime risk of breast cancer?
80% lifetime risk
35
BRCA2 is associated with what lifetime risk of ovarian cancer?
20%
36
BRCA2 is associated with what lifetime risk of breast cancer?
50%
37
BRCA 1/2 is what type of inheritance?
Autosomal Dominant
38
Inheritance pattern for LYNCH syndrome?
Autosomal Dominant
39
What percentage of uterine cancer is related to LYNCH syndrome?
3%
40
What is the recommended screening for colonoscopy in LYNCH patients?
colonoscopy every 1-2 years starting at 20 - 25 yrs of age OR 2 years prior to the earliest family cancer
41
What is the recommended screening for endometrial biopsy in LYNCH patients?
Endometrial biopsy every 1 - 2 years starting at age 35
42
When do you recommend a risk reducing hysterectomy/BSO in patients with LYNCH syndrome?
mid 40s
43
What is the lifetime risk (by age 70) for colon cancer in LYNCH patient?
80% lifetime risk
44
What is the lifetime risk (by age 70) for endometrial cancer in LYNCH patient?
60% lifetime risk
45
What is the lifetime risk (by age 70) for ovarian cancer in LYNCH patient?
10% lifetime risk
46
Cowden's disease is associated with an increase in what types of cancer?
Breast cancer, endometrial cancer, colon cancer
47
Li Fraumeni syndrome is associated with an increase in what types of cancer?
Breast and colon cancer
48
Peutz Jeghers syndrome is associated with an increase in what types of cancer?
Breast, ovarian, colon
49
What does SGO recommend in terms of ovarian cancer screening for BRCA patients?
Screen every 6 months with CA 125 and TVUS starting at age 30 - 35 years OR 5-10 years before earliest age of first cancer in family
50
When during the menstrual cycle should you get a screening CA 125 in a BRCA patient?
Day 5
51
When during the menstrual cycle should you get a screening TVUS in a BRCA patient?
Day 1-10
52
What stages of ovarian cancer do not require adjuvant chemotherapy?
Stage IA, IB AND grade 1, 2
53
What is the standard chemotherapy used in the treatment of ovarian cancer and how many cycles?
Carboplatin and Paclitaxel, 6 cycles
54
What proportion of patients with ovarian cancer are diagnosed at stage I and what is the survival rate?
20% diagnosed at stage I, 70% survival rate
55
What proportion of patients with ovarian cancer are diagnosed at stage II and what is the survival rate?
5% diagnosed at stage 2, 45% survival rate
56
What proportion of patients with ovarian cancer are diagnosed at stage III and what is the survival rate?
58% diagnosed at stage 3, 20% survival rate
57
What proportion of patients with ovarian cancer are diagnosed at stage IV and what is the survival rate?
17% diagnosed at stage 3, 10% survival rate
58
What is the definition of Stage IA ovarian cancer?
Tumor limited to one ovary (capsule intact) or fallopian tube
59
What is the definition of Stage IB ovarian cancer?
Tumor limited to BOTH ovaries (capsule intact) or BOTH fallopian tubes
60
What is the definition of Stage IC1 ovarian cancer?
Tumor limited to one or both ovaries with capsule rupture DURING SURGERY
61
What is the definition of Stage IC2 ovarian cancer?
Tumor limited to one or both ovaries with capsule rupture PRIOR to SURGERY
62
What is the definition of Stage IC3 ovarian cancer?
Tumor/ Malignant cells in ascites or peritoneal washings
63
What is the definition of Stage IIA ovarian cancer?
Extension or implants on the uterus
64
What is the definition of Stage IIB ovarian cancer?
Extension to other pelvic tissues (colonic implants, retroperitoneal surface implants ect.)
65
What is the definition of Stage IIIA ovarian cancer?
Positive retroperitoneal lymphnodes OR microscopic metastases beyond the pelvis
66
What is the definition of Stage IIIB ovarian cancer?
Macroscopic abdominal peritoneal metastasis < 2 cm
67
What is the definition of Stage IIIC ovarian cancer?
Macroscopic abdominal peritoneal metastasis > 2 cm
68
What is the definition of Stage IVA ovarian cancer?
Pleural effusion with positive cytology
69
What is the definition of Stage IVB ovarian cancer?
Parenchymal metastases and mets to extra-abdominal organs
70
What is the most common type of ovarian cancer, what is the percentage?
Epithelial, 90%
71
Of the epithelial ovarian cancers, what is the most common type, what is the percentage?
Serous, 50%
72
High grade serous is associated with what genetic abnormalities?
BRCA1, BRCA2, TP53
73
What is the percentage of ovarian cancer that is endometriod subtype?
25%
74
What is the percentage of ovarian cancer that is Mucinous subtype?
10%
75
What is the percentage of ovarian cancer that is clear cell subtype?
5%
76
What is the treatment strategy for neoadjuvant chemotherapy in ovarian cancer
Carboplatin + Taxol q 3 weeks for 3 cycles, followed by cytoreductive surgery, followed by 3 more cycles or carbo/taxol q 3 weeks
77
What agents are used for maintenance therapy in ovarian cancer patients?
Bevacizumab, or PARP inhibitors (Olaparib)
78
What needs to be done for surveillance in terms of studies for ovarian patients?
CA 125 and physical exam
79
What is the frequency and duration of surveillance for ovarian cancer patients?
every 3 months for 2 years and every 6 months for 3 years
80
What are the 5 types of germ cell tumors?
1. Immature teratoma
2. Dysgerminoma
3. Endodermal Sinus/yolk sac tumor
4. Embryonal carcinoma
5. Choriocarcinoma
81
What is the most common germ cell tumor?
Dysgerminoma
82
What are the tumor markers associated with Dysgerminoma?
LDH, bHCG
83
What are the tumor markers associated with yolk sac tumors?
AFP
84
What are the tumor markers associated with Choriocarcinoma?
bHCG
85
What are the tumor markers associated with Embryonal carcinoma?
AFP, bHCG
86
What are the tumor markers associated with immature teratoma?
AFP, LDH, CA125
87
True or False: unilateral salpingo-oophorectomy is an option for fertility sparing treatment in a patient with a germ cell tumor
True
88
What typical chemotherapy regimen is used with germ cell tumors?
BEP - Bleomycin, Etoposide, Carboplatin
89
True or false: Germ cell tumors are NOT very chemotherapy sensitive
False
90
What does the grading of an immature teratoma depend on?
amount of immature neuroectoderm
91
What stage of disease of an immature teratoma DOES NOT require chemotherapy
Stage IA grade 1
92
What are patients with dysgenetic gonads (phenoypic female with 46 XY) at increased risk for?
Dysgerminoma
93
What pathology is associated with dysgerminomas?
epitheliod cells with mature lymphocytes with fibrous septae
94
What gross pathology is associated with endomdermal sinus tumors/yolk sac tumors?
solid, necrotic, friable and yellowish tissue
95
What cytologic characteristic is associated with endomdermal sinus tumors/yolk sac tumors?
Schiller-Duval bodies
96
What germ cell tumor has the worst survival rates?
Yolk Sac Tumor
97
Ovarian sex chord stromal tumors account for what proportion of ovarian cancer?
5%
98
What are the two common sex chord stromal tumors?
1. Granulosa cell tumors
| 2. sertoli-Leydig tumor
99
What are the tumor markers for Granulosa cell tumors?
Inhibin A, Inhibin B
100
What is the gross pathology of Granulosa cell tumors?
Solid/Cystic with blood fluid
101
What cytologic characteristic is associated with granulosa cell tumors?
Call-Exner bodies , Coffee bean nuclei
102
What concurrent procedure should always be performed in a patient with a granulosa cell tumor?
EMB or evaluation of endometrium
103
What chemotherapy regimen should be used with a granulosa cell tumor?
BEP
104
What is the survival rate for stage I-II granulosa cell tumor
85%
105
What is the survival rate for stage III-IV granulosa cell tumor?
35%
106
What is the gross pathology of Sertoli-Leydig tumors?
Sertoli tubules, clusters of leydig cells in intervening stroma
107
What cytologic characteristic is associated with Sertoli-Leydig tumors?
Reinke Crystals - rod like cytoplasmic inclusions
108
What chemotherapy regimen should be used with a Sertoli-Leydig Tumor?
BEP
109
What is the 5 year survival rate for Sertoli-Leydig tumors?
70 - 90%
110
What is MEIG syndrome?
FIBROMA associated with pleural effusions and ascites
111
What ovarian tumor is associated with MEIG syndrome?
Ovarian fibroma
