Flashcards in Pathophysiology of Ovarian Cancer Deck (24)
For what is ascites, omental caking, and a pelvic mass a typical presentation?
Ovarian epithelial cancer.
What is CA125? What is its utility?
Cancer antigen 125 - it's a marker elevated in most women with ovarian cancer, but it's not specific at all. Any irritation to the peritoneum can cause elevation.
However, it can be useful for monitoring response to treatment.
How does ovarian epithelial cancer spread?
Primarily by exfoliation into the peritoneal cavity.
(also direct extension, lymphatic, and hematogenous)
What is a probably reason for an assymetrical spread of mets / implants into the peritoneum?
Peritoneal fluid tends to rotate in a clockwise manner....
What's the most lethal gynecological cancer? Why?
Epithelial ovarian cancer. There's no good screening test, and it often isn't caught until late stage.
Review: What are the main types of epithelial ovarian cancer?
Serous (most common)
How are LMP tumors managed differently?
No adjuvent chemo unless implants are invasive.
2 theories as to the pathogenesis of epithelial ovarian cancer?
Incessant ovulation -> repeated trauma to ovarian epithelium.
Excess gonadotropins -> excess estrogen leads to hyperplasia
What does primary peritoneal cancer have to do with epithelial ovarian cancer?
Peritoneum is under same influences as epithelium of ovaries. Adenocarcinoma there appears identical microscopically to ovarian adenocarcinoma.
Similar treatment and clinical course.
Common presentation of ovarian cancer?
Asymptomatic mass on pelvic exam.
Non-specifc mass-related symptoms:
- Abdominal swelling, pain.
- Urinary frequency.
- Weight change
Treatment for ovarian epithelial cancer?
Staging - with exploratory surgery.
Does debulking effect prognosis?
Yes. If you take away all the visible tumor, people live longer and respond better to chemo.
Chemotherapy of choice for ovarian epithelial cancer?
Carboplatin + Paclitaxel
(platinum + anti-tubules drugs)
What's the normal course of ovarian cancer like with treatment?
70% respond to first-line chemo, but vast majority have recurrence within 2 years.
Second-line treatments have response rates of 15-25%.
Does giving more types and high levels of chemo help?
Nope - at least not with the drugs currently available.
What is one way that actually makes chemotherapy work better?
Give in intraperitoneally instead of IV. The toxicity is worse, but survival was increased by 14mo.
How do germ cell tumors spread?
(as opposed to peritoneally)
When is the peak incidence of malignant germ cell tumors in women?
What's one way germ cell tumors can present in women?
In 10% of cases, presents acute abdomen (jargon for severe acute abdominal pain), due to rupture, torsion, hemorrhage.
How are germ cell tumors treated?
Surgery, chemo, radiation - details depend on what type it is.
Review: What's a notably radiosensitive germ cell tumor in women?
What's the chemo regimen of choice for germ cell tumors?
BEP: Bleomycin, Etoposide, Cisplatin
Do women remain fertile after treatment for germ cell tumors?