Ovarian tumours

Question 1

More common in pre/post menopausal women?

Answer 1

Post-menopausal women

Question 2

Ovarian cancer - Risk factors

Answer 2

Increasing age - over 50
Nulliparity
Delayed pregnancy
Family history of ovarian and breast cancer

Question 3

Ovarian cancer - Genetics

Answer 3

BRCA 1 and 2

HNPCC (Lynch syndrome)

Question 4

Ovarian cancer - clinical features

Answer 4

Gradual symtoms 
Pelvic mass 
Persistent bloating 
Early satiety 
Abdominal pain 
Ascites 
Pressure symptoms (esp in bladder)
Change of bowel habit 
Weight loss 
Pleural effusion
SOB

Question 5

Ovarian cancer often presents non-gynaecological. True or false?

Answer 5

True

Question 6

Ovarian cancer - name 2 tumour markers

Answer 6

CA125

Carcino-embryonic antigen (CEA)

Question 7

Normal levels of CA125 excludes ovarian cancer - true or false?

Answer 7

False

Question 8

CA125 is raised in ovarian cancer ONLY. True or false?

Answer 8

False

- can be raised in other benign conditions such as endometriosis

Question 9

Ovarian cancer - investigations

Answer 9

Tumour markers 
- CA125
- CEA 
Imaging 
- Transvaginal/abdo US 
- CT

Question 10

Ovarian cancer - investigations - US findings

Answer 10

Complex mass with SOLID and CYSTIC area 
Multi-loculated 
Thick separations 
Associated ascites 
Bilateral disease

Question 11

Ovarian cancer - investigations - what is the role of CT

Answer 11

Assess disease outwith the ovary

Question 12

Screening is performed routinely for ovarian cancer. True or false?

Answer 12

False

Question 13

Ovarian cancer - staging

Answer 13

FIGO stage

4 stages

Question 14

Ovarian cancer - stage I

Answer 14

Confined to 1 or both ovaries
IA - cancer in one ovary
IB - cancer in both ovaries
IC - cancer in ovary and on the surface of one ovary

Question 15

Ovarian cancer - stage II

Answer 15

Spread to other local pelvic organs e.g. uterus, fallopian tubes

Question 16

Ovarian cancer - stage III

Answer 16

Spread beyond the pelvis within the abdomen

Question 17

Ovarian cancer - stage IV

Answer 17

Spread into other organs e.g. liver, lungs

Question 18

Ovarian cancer - management of treatable disease

Answer 18

Surgery

- bilateral salpino oophrectomy

Question 19

Ovarian cancer - management of advanced disease

Answer 19

Surgery + Chemotherapy

Question 20

What is the first line chemotherapy treatment of epithelial ovarian cancer?

Answer 20

Platinum agent

• carboplatin
• paclitaxel

Question 21

Management of relapsed ovarian cancer in a platinum sensitive patient

Answer 21

Platinum based combination with paclitaxel, PLDH or gemcitabine

Question 22

Management of relapsed ovarian cancer in a platinum resistant patient

Answer 22

Hormonal therapy

Question 23

The OCP is protective against ovarian cancer. True or false?

Answer 23

True

Question 24

If you have genetic testing and carry the BRCA mutation, what should you have removed?

Answer 24

Mastectomy
Take out ovaries
Take out fallopian tubes

Question 25

Primary ovarian tumours - where do the majority arise from?

Answer 25

Surface epithelium

Question 26

Primary ovarian tumours - Name 3 locations they can arise from?

Answer 26

Surface epithelium Germ cells Stroma

Question 27

Primary ovarian tumours - Epithelial tumours - subtypes (5)

Answer 27

``` Serous Mucinous Endometrioid Clear cell Brenner ```

Question 28

Primary ovarian tumours - Epithelial tumours - benign form

Answer 28

No cytological abnormalities Proliferative activity absent No stromal invasion

Question 29

Primary ovarian tumours - Epithelial tumours - brotherliness form

Answer 29

Cytological abnormalities Proliferative activity No stromal invasion

Question 30

Primary ovarian tumours - Epithelial tumours - malignant form

Answer 30

Stromal invasion

Question 31

Primary ovarian tumours - Germ cell tumours - benign

Answer 31

Benign cystic teratoma (dermoid cyst)

Question 32

Primary ovarian tumours - Germ cell tumours - malignant

Answer 32

Malignant germ cell tumours

Question 33

Primary ovarian tumours - Stromal tumours - if the are i the inner layer (granolas cells) then they are more/less likely to secrete oestrogen?

Answer 33

More

Question 34

Primary ovarian tumours - Epithelial tumours - what is the most common type of ovarian cancer?

Answer 34

Serous carcinoma

Question 35

Primary ovarian tumours - Epithelial tumours - endometrioid and clear cell

Answer 35

Most are low grade and early stage | - usually confined to ovary at presentation

Question 36

Primary ovarian tumours - Epithelial tumours - endometrioid and clear cell - associated conditions

Answer 36

Endometriosis of the ovary | Lynch syndrome

Question 37

Primary ovarian tumours - Epithelial tumours - brenner tumour is most commonly benign/malignant?

Answer 37

Benign

Question 38

Primary ovarian tumours - Epithelial tumours - brenner tumour - definition

Answer 38

Bengin tumour of transitional type epithelium

Question 39

Primary ovarian tumours - germ cell tumours - dermoid cyst

Answer 39

Can differentiate into anything - teeth - hair - sebaceous material

Question 40

Primary ovarian tumours - germ cell tumours - malignant germ cell tumours - who gets it ?

Answer 40

Young women and children | Very rare

Question 41

Primary ovarian tumours - stromal tumours - granulosa cell tumour - definition

Answer 41

May produce oestrogen

Question 42

Primary ovarian tumours - stromal tumours - granulosa cell tumour - clinical features

Answer 42

Precocious puberty | Post menopausal bleeding

Question 43

Primary ovarian tumours - stromal tumours - thecal tumour - definition

Answer 43

May produce androgens (testosterone)

Question 44

How does ovarian cancer commonly spread ?

Answer 44

Transperitoneal spread - ascites with protein exudate - omental disease/infiltration - peritoneal nodules

Question 45

Ovarian cancer - initial diagnosis is made by which imaging?

Answer 45

US

Question 46

What is the main risk factor

Answer 46

The number of times a woman ovulates - nulliparity - increased age - early menarche / late menopause

Question 47

COCP and ovarian cancer

Answer 47

COCP reduces risk of developing ovarian cancer

Question 48

What is HNPCC

Answer 48

lynch syndrome

Question 49

What is the most common type of ovarian cancer?

Answer 49

Serous tumour

Question 50

Which type of ovarian cancer has an association with lynch syndrome?

Answer 50

Endometrioid tumour

Question 51

Brenner tumour is a tumour of which type of epithelium

Answer 51

Transitional epithelium

Question 52

Benign ovarian tumour + pleural effusion + ascites | which condition does this make you think of?

Answer 52

Meig's syndrome

Question 53

Germ cell tumours tend to affect older women/younger women ?

Answer 53

Younger

Question 54

65% germ cell tumours produce elevated

Answer 54

HcG and AFP

Question 55

if cancer extends or implants on uterus/fallopian tubes, what stage is it ?

Answer 55

Stage 2

Question 56

If cancer extends into the lining of the abdomen, what stage is it?

Answer 56

Stage 3A or 3B

Question 57

Mainstay of treatment of epithelial tumours in patients fit for surgery

Answer 57

Debulking surgery + chemotherapy

Question 58

Relapsed ovarian cancer, what is the treatment of choice?

Answer 58

Chemotherapy