Ovarian Tumors Flashcards by Richhpal Singh

Increased scars on ovary surface can be seen in cases of

Nulliparous
Ovulation induction
Early menarche
Late menopause
Perineal talc
Asbestosis
These all increases predisposition to epithelial injury

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Increased scars on ovary can lead to

Epithelium of ovary tries to heal by itself - can lead to overhealing due to repeated injuries - Can eventually cause Epithelial Ovarian cancers

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Which gene mutations increase predisposition to ovarian cancer

BRCA 1 - Chr 17
BRCA 2 - Chr 13

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Chances of ovarian cancer If two 1st degree relatives with female specific cancers

35-40%

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Chances of ovarian cancer if one 1st degree and one 2nd degree relatives with female specific cancers

2-10 times chances

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Age group mostly affected in case of Ovarian cancers

Elderly (6th to 7th decade)

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Ovarian cancer is associated with increase in which Prognostic marker

CA125

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CA125 significant values in postmenopausal and premenopausal women

> 35 - postmenopausal
200 - in premenopausal

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Which is the most common ovarian cancer

Epithelial Ovarian cancer - 70%

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Which is the biggest tumor of mankind

Ovarian tumor

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USG Features of Malignancy in case of Ovarian Cancers

Transvaginal > Transabdominal
Bilateral tumor
Multiloculated
Surface irregularities
Cystic + Solid areas in same tumor
A/w ascites
Metastasis

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Risk of Malignancy index (RMI) Includes

Menopausal status
Ultrasound features
Sr CA 125

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Which is specific marker for Ovarian cancer

Human epidydimis Protein 4 (HE-4) - 94% specificity
No effect with endometriosis

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(Risk od Malignancy Algorithm) ROMA cutoff values for premenopausal and postmenopausal women

7.4% for premenopausal
25.3% for postmenopausal

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Best treatment modality for Ovarian cancers

Staging Laparotomy + Optimal debulking

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All cancers in Gyne are staged by and exception

Staged surgically except Ca Cervix (Staged clinically)

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Steps for Staging Laparotomy and Optimal debulking

1) Vertical abdominal incision
2) If ascites/washings 50-100ml NS of pouch of Douglas,paracolic gutters
3) Assess the tumor and spread in clockwise manner (to check organ involvement)
4) Peritoneal biopsies
5) Scrape both hemidiaphragm
6) Supracolic omentectomy - send for pathology
7) Retroperitoneal LN sampling - Pelvic, Paraaortic LN

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Optimal Debulking AKA

AKA Cytoreduction
Residual cancer is less than 1cm size
Post operative period - lesser morbidity

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FIGO Staging for Ovarian cancers

Stage 1 - Stage 1A, Stage 1B , Stage 1C ( C1,C2,C3)
Stage 2 - Stage 2A, Stage 2B
Stage 3 - Stage 3A1, Stage 3A2, Stage 3B, Stage 3C
Stage 4 - Stage 4A, Stage 4B

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Stage 1 of Ovarian cancer

Ovarian involvement
Stage 1A - one ovary involved
Stage 1B - Both ovary involved
Stage 1C - A or B + Surgical spill (C1), Surface growth (C2), Malignant ascites or washings (C3)

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FIGO Stage 2 of Ovarian cancers

Involvement of Pelvis
Stage 2A - uterus, fallopian tubes
Stage 2B - other pelvic organs involvement

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FIGO Stage 3 of ovarian cancer

Abdominal involvement
Stage 3A1 - Retroperitoneal LN involvement
Stage 3A2 - Microscopic Abdominal involvement
Stage 3Bb - Macroscopic Abdominal involvement <2cm
Stage 3C - Macroscopic Abdominal involvement >2cm
Liver and spleen superficial involvement

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FIGO Stage 4 of ovarian cancer

Stage 4A - Malignant pleural effusion
Stage 4B - Deep liver and spleen deposits, Inguinal LN

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Chemotherapy regimes used for Epithelial Ovarian cancer

CAP Regime - Cyclophosphamide, Adriamycin, Platins (Cisplatin, Carboplatin)
PT Regime - Platins, Taxol

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Which Regime is best in case of Epithelial Ovarian cancers

PT Regime

Chemotherapy regimes for Germ cell Tumors

VBP - Vincristine, Bleomycin, Platins BEP - Bleomycin, Etoposide, Platins : Better

Treatment for Sex cord tumors

Surgery is sufficient

Ovarian tumors are radioresistant or sensitive and exception

Ovarian tumors are Radioresistant except Dysgerminoma (Only Radiosensitive ovarian tumor)

Normal ovaries are Radioresistant or sensitive

Radiosensitive

Management of Early low risk Ovarian cancer

Low risk - Stage 1A, 1B Surgical staging

Management of Early high risk Ovarian cancers

High risk - Stage 1C Surgical Staging + Adjuvant Chemotherapy

Management of Advanced ovarian cancer

Stage 2,3 and 4 Maximal Cytoreduction ( Removal of entire pelvic tumor + resection of metastasis) + Adjuvant Chemotherapy

Fertility sparing surgery can be done in which stage of ovarian cancer

Stage 1A with low grade, Borderline tumors U/L salpingo-oopherectomy

Neo adjuvant Chemotherapy is given in cases of

Stage 3 and 4 with massive ascites, pleural effusion or unresectable tumor

Types of Epithelial Ovarian tumor

Serous cyst adenoma Mucinous cyst adenoma Brenner tumor Endometroid tumor Clear cell carcinoma/Mesonephroid tumor

Most common subtype of Epithelial Ovarian cancers

Serous cyst adenoma

Bodies seen in case of Serous cyst adenoma

Psammoma bodies

Serous cyst adenoma cells resembles like cells of which organ

Fallopian tubes

Serous cyst adenoma Features

Unilocular Tumor B/L in 50% cases Mostly malignant Surface growth can be seen

In mucinous cyst adenoma, cells resembles like of

Cervical cells

M/C cause of Pseudomyxoma peritonei in ovarian tumors and overall

In ovarian tumors - Mucinous cyst adenoma Overall - Carcinoma of appendix

Mucinous cyst adenoma features

Lesser malignant then Serous cyst adenoma 10% are B/L Multilocular Tumor Pseudomyxoma peritonei - Severe Hypoproteinemia

In Brenner tumor, cells resembles like which organ

Bladder - made up of Transitional cells

Nest of Transitional cells in Brenner tumor is termed as

Walthard inclusions (Puffed wheat type of cells)

Brunner tumor consistency

Rubbery tumor Benign

Brenner tumor is associated with which Syndrome

Pseudomeig Syndrome Post Menopausal bleeding

Pseudomeig Syndrome and M/C seen in case of

Any ovarian tumor other than Fibroma with ascites and Pleural effusion M/C bcz of Brenner tumor

Meig Syndrome Triad

Fibroma Ascites Pleural effusion

Endometroid tumor cells resembles to which organ

Endometrial type of cells 6-8% of all Ovarian cancers

Which Epithelial Ovarian tumor is rare but very malignant

Clear cell carcinoma/Mesonephroid tumor

Histological findings in case of Clear cell carcinoma/Mesonephroid tumor

Large cuboid cells, Clear cytoplasm Hobnail cells - Cystic space lined by clear cells with protruding nucleus into lumen

Germ cells tumors are usually seen in which age group

Younger women Mostly unilateral

Subtypes of Germ Cell Tumors and M/C

Teratoma - M/C Dysgerminoma Yolk sac tumor Embryonal Tumor Sex cord tumors - Granulosa cell tumors, Sertoli Leydig cell tumor

Most common tumor of Pregnancy and Torsion

Teratoma

Teratoma is benign or malignant?

10% Malignant 90% Dermoid/Benign cystic Teratoma

Germ layers involved in Teratoma

Involves all germ layer derivatives - may have bone, teeth, sebaceous secretions, hairs in it

Most common cause of Germ cell malignancy

Dysgerminoma (40-45%) Only B/L germ cell malignancy (10-15%)

Dysgerminoma is associated with

Dysgenic gonads

Type of cells in Dysgerminoma

Have Seminoma type of cells - large polygonal cells, Clear cytoplasm and dark staining nuclei with back to back arrangement

Dysgerminoma is associated with increase in which markers

LDH Placental Alkaline phosphatase AFP not increased

Yolk sac tumor AKA

Endodermal sinus tumor

Markers increased in case of Yolk sac tumor

AFP Alpha 1 antitrypsin - more specific

Bodies seen in case of Yolk sac tumor

Schiller duval bodies

Yolk sac tumor and Embryonal tumors are usually seen in which age group and prognosis

Seen in young women, girls Poor prognosis

Markers increased in case of Embryonal tumor

AFP HCG - more specific

Subtypes of Sex cord tumors

Granulosa cell tumors Sertoli/Leydig cell tumor

Estrogen levels in Granulosa cell tumors and results in

Estrogen level increases - Precocious puberty, Menorrhagia, Predisposes to endometrial cancer

Marker for Granulosa cell tumors

Inhibin

Bodies seen in case of Granulosa cell tumors

Carlexner bodies

Sertoli Leydig cell tumor AKA

Androgen producing Arrhenoblastoma

Sertoli Leydig cell tumor C/F

Hirsutism/Virilization Oligomenorrhea to Amenorrhea

Difference between Hirsutism and Virilization

Hirsutism - Reversible Virilization - Permanent changes (Hoarseness of voice, Breast changes,Clitromegaly)

Causes of Rapid onset Hirsutism

Ovarian tumor Adrenal Tumors

Causes of Puberty Hirsutism

Congenital Adrenal hyperplasia

Cause of Adult onset Hirsutism

Polycystic Ovarian Syndrome (PCOS)

Overall M/C of Hirsutism

PCOS

Non-Neoplastic Ovarian cysts includes

Follicular cyst Corpus luteal cyst Theca lutein cyst Hemorrhagic cyst

Theca lutein is seen due to increased

hCG Can be seen in molar pregnancy or twins

Most common ovarian tumor of Pregnancy

Dermoid then serous cyst

Management in pregnancy If Tumor is small (<5cm) and asymptomatic

No treatment is required

Management in pregnancy If Tumor is large (>10cm) and asymptomatic

Remove in 2nd trimester

Management in pregnancy If Tumor is largev(>10cm) and diagnosed in 3rd trimester

Postnatal within 1-2 wks or along with a C section

Most common tumor secondary to Ovary

Ca Stomach > Ca breast Krukenberg tumor

Histological finding in case of Krukenberg tumor

Signet ring cells

Features of Borderline epithelial ovarian Tumors

Epithelial hyperplasia Mitotic activity in cells, Nuclear atypia Detached cell clusters No destructive stromal inclusion

Ovarian Tumors Flashcards

(85 cards)