(Iii-Obgyn) Ovarian And Fallopian Tube Tumors

Front 1

Percentage of ovarian tumors that are benign:

Back 1

80%

Front 2

Ovarian cancer is the _____ most common cancer of the genital tract:

1. First
2. Second
3. Third

Back 2

Third most common. Accounts for 25% of all gynecologic malignancies, but responsible for over 50% of deaths

Front 3

Tumors of the ovaries are derived from one of the three distinct components of the ovary.

Name them:

Bonus, which is the most common component involved in malignancy?

Back 3

Epithelium
Stroma
Germ cells

By far most cancers originate from the epithelium (90%)

Front 4

What is it called when a tumor from the GI breast or endometrium metastasizes to the ovary?

Back 4

Krukenbern

Front 5

How is ovarian cancer spread?

Back 5

Direct exfoliation of malignant cells (usually into peritoneal fluid)

However, lymph and hematogenous spread are also possible.

Front 6

What is Lynch II Syndrome?

Back 6

HNPCC

Front 7

Which carries a higher risk of ovarian cancer: BRCA1 or BRCA2?

Back 7

BRCA1

Front 8

The risk for ovarian cancer seems to be linked to long periods of uninterrupted ovulation. What are some conditions that can lead to this?

What are some other risk factors for ovarian cancer?

Back 8

Nulliparous
Decreased fertility
Delayed childbearing
Late-onset menopause

Other risk factors include use of talc, high fat diet, lactose intolerance, colon cancer or breast cancer.

Front 9

Are OCPs protective or a risk factor for ovarian cancer?

Back 9

Protective

Front 10

Although most patients with ovarian carcinoma are asymptomatic, what what are some symptoms that pts may have?

Back 10

Vague lower abdominal pain
Early satiety
Urinary changes
Ascites in later stages
Ventral hernia

Front 11

Ovarian mets to the umbilius is known as____

Back 11

Sister Mary Joseph nodule

Front 12

There are six common subtypes of surface epithelial tumors. Name them:

Back 12

Serous
Mucinous
Endometroid
Clear cell
Brenner
Undifferentiated

Front 13

Primary diagnostic tool for investigating an adnexal mass:

Back 13

Pelvic ultrasound

Other studies include CT and MRI

Avoid paracentesis

Front 14

Common surgical procedure for ovarian cancer staging:

Back 14

TAH/BSO, omenectomy, peritoneal washing and cytology, sampling of pelvic and para-aortic lymph nodes

Front 15

The majority of patients with newly diagnosed ovarian cancer present with which stage:

Back 15

Stage III

Front 16

Most common type of malignant epithelial cancer?

Back 16

Serous cystadenocarcinoma

Front 17

Are epithelial tumors slow or fast growing?

Back 17

Slow growing

Pts may not notice them

Front 18

CA-125 is associated with which type of tumor?

Back 18

Epithelial tumors

Front 19

Common chemo therapy following surgery for epithelial ovarian cancer?

Back 19

Carboplatin and Paclitaxel

Front 20

What tumor has a motor oil appearance?

Back 20

crainopharyngioma may also have teeth.

Front 21

Which stage?
Growth Limited to the ovaries

Back 21

Stage I

Ia: One ovary involved
Ib: Both involved
Ic - Rupture of ovarian surface tumor leading to positive peritoneal cytology

Front 22

Which stage?
Disease extension to abdominal cavity

Back 22

Stage III

IIIa- Micro mets
IIIb - Tumor mets > 2 cm
IIIc Mets to lymph nodes

Front 23

Which stage?
Distant mets

Back 23

Stabe IV

Includes malignant pleural efusion, liver or splenic parenchymal mets
Mets to the skin

Front 24

Which stage: Disease extension from ovary to the pelvis:

Back 24

Stage II

IIa - Extension to uterus or fallopian tube
IIb- Extension to other pelvic tissues
IIc - Either IIa or IIb with rupture of surface tumor

Front 25

What are the two most common types of germ cell tumors?

Back 25

Dysgerminomas
Immature teratomas

Front 26

In general dysgerminomas produce this marker:

Back 26

LDH

Front 27

In general choriocacinomas produce this marker:

Back 27

hCG

Front 28

In general embryonal sinus tumors produce this marker:

Back 28

AFP

Front 29

If a 18 year old was found to have malignant ovarian cancer, which type would you suspect?

Back 29

Germ cell tumor

Front 30

Why are germ cell tumors associated with a better prognosis than epithelial tumors?

Back 30

Because they grow much more rapidly and can be detected at an earlier stage

Front 31

T/F

Germ cell tumors are rarely bilateral so you can do a unilateral salpingo-oophorectomy

Back 31

True

Front 32

Most germ cell tumors do not respond to radiation, except one.

Name it:

Back 32

Dysgerminoma

However, this isn't offered to all patients due to the risk of infertility.

Front 33

Chemotherapy regimen for germ cell tumors:

Back 33

BEP

B: Bleomycin
E: Etoposide
P: CisPlatin

Front 34

What age do sex cord stromal tumors typically show up?

Back 34

Can occur in any age, but usually between 40 and 70

Front 35

Which type of functional tumor will produce androgens?

Back 35

Sertoli-Leydig cell tumors

Front 36

Which type of functional tumor will produce estrogen?

Back 36

Granulosa-theca cell tumors

Front 37

What is Meig's syndrome?

Back 37

Ovarian tumor
Ascites
Hydrothorax

Front 38

What special diagnostic step must you do in granulosa - theca tumors?

Back 38

Endometrial sampling since unopposed estrogen can lead to endometrial cancer

Front 39

T/F Because most sex cord-stromal tumors are bilateral, you should offer TAH/BSO to affected pts.

Back 39

False.

They tend to be unilateral, so you only offer TAH/BSO to women who no longer plan on having children

Front 40

Which tend to reoccur down the road?

Sertoli-Leydig cells or Gransulosa tumors

Back 40

Granulosa tumors

Front 41

Most fallopian tube cancers are _____ arising from the mucosa of the tube

Back 41

Adenocarcinoma

Front 42

Percentage of fallopian cancers that are not primary:

Back 42

10 to 20%

Front 43

Classic triad of symptoms for fallopian tube cancer?

Back 43

Watery discharge
Pelvic pain
Pelvic mass

(Hydrops tubae profluens)

Front 44

Treatment for fallopian tube cancer

Back 44

Same as for epithelial ovarian cancer (see those flashcars)

Front 45

Prognosis for fallopian tube cancer is most similar to which type of ovarian cancer?

Back 45

Epithelial ovarian cancer

Overall 5 year survival is 40%