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38 Cards in this Set
- Front
- Back
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State at what stage ovarian cancer usually presents
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it is notoriously silent at the onset and usually presents in stage III. It is one of the most common gyn malignancies
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List risk factors for ovarian cancer and state the peak age of incidence
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Primarily caucasian women with peak at 50-70 year old age. Risks are women with more than 40 ovulation years, women with a late menopause and those over 45 with nulliparity or first pregnancy after age 30
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Discuss the connection between ovarian cancer and breast and colon ca
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they may have a common etiology. The ovary is also a common site of mets from primary colon ca. and a 3-4 fold increase in developement of breast ca and women with breast ca have a 2 fold increase risk for dev of ovarian ca
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List the most common symptoms associated with ovarian ca
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This silent killer has minimal vague lower abd, nausea, and pelvic complaints are nonspecific and ignored by the pt. also increased farts, sense of bloating, and mild digestive disturbances, and have jelly-belly appearance (ascites). Early sign is enlargement of left supraclavicular lymph node.
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List 2 serum markers which may indicate ovarian ca
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Pelvic ultrasound is useful as are blood test which may reveal elevated serum markers CEA and CA125
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State the most common histologic type of ovarian ca
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More than 90% of malignant ovarian carcinomas are epithelial in origin, the main type is serous adenocarcinoma, with mucinous and endometrioid being common as well. Epithelial cell ca- germ cell tumors, sex cord stromal tumors also
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State which type of ovarian ca is most likely to present bilaterally.
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serous adenocarcinoma
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State which type of ovarian ca has the worst prognosis
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undifferentiated adenocarcinoma
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Discuss germ cell tumors and state which form of germ cell tumor is most common
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Characterized by rapid growth and are normally encountered in childern or young adults. They tend to Mets to lymph nodes. most common is dysgerminoma.
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Discuss dysgerminomas: give the RT dose needed to cure them and state the 5 year survival
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very radiosensitive RT dose of 2400 cGy to treat and cure, 5 yr/ 82%
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List and discuss the four methods of spread for ovarian ca and state which is most common
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-direct- occurs once the tumor has breached the capsule of the ovary and involves the pelvic peritoneum and pelvic organs
-transcoelomic (seeding) MAIN*- may shed cells thru peritoneal cavity and diaphragm area -lymphatic- from ovaries into periaortic nodes -blood- usually is late |
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State where the main lymphatic drainage for the ovaries
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periaortic nodes
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List the organs which are the most common extrapelvic metastiatic sites of ovarian ca
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liver and lung
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Discuss the incidence of bone mets from ovarian ca
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ovarian bone mets are rare
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State which modality is considered the primary treatment for ovarian ca
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Surgery, goal is to remove as much of the disease as possible thru total abd hysterectomy, bilateral salpingo-oophorectomy or omentectomy
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Define "second look" surgery, conservative surgery
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Adjuvant RT or chemo is more effective after surgery. Pts with no evidence of clinical disease after receiving appropriate adj treatment should have a "second - look" operation approx 1 yr after initial tx
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Discuss post operative treatment of ovarian ca
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includes chemo and/or RT, most effective contain cisplatin.
-Chemo for stage IV -intraperitoneal administration of chemo cisplatin and 5FU directly to tumor |
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Describe the major alternative to chemo for adj tx of ovarian ca
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External RT- whole abd cavity using 1. a single large field- max dose 3000 in 5 wks, above the diaphragm to below symphasis *sheild kidneys 2. moving strip technique- treats 2.5 cm strips at on time, which limits nausea and diarrhea
-also intrapertioneal baths with radioisotopes (stage I and II) P32 and gold (Au 198) |
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Ovarian ca incidence is #__ with exception of _____, which has lowest mortality rate worldwide
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#2
Japan |
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Etiology of ovarian ca
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-diet rich in viatamin A reduces risk
-asbestos workers and cosmetic talc associated with condom and diaphragm use- high incidence |
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Ovarian ca is known to run in families. Women with mother or sister risk increase ____. And should consider ___________ is they plan no more children.
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20 fold
prophylactic oophorectomy |
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Detection of ovarian ca is curable if detected early, and physicians would have to _________ for women at high risk
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regular and through abd-pelvic exams
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In whole abd field RT kidneys must be shielded at
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2000
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Dose limiting structures for RT ovarian ca are
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-kidney
-liver -intestines -bone marrow |
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Reaction with RT of ovarian ca
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-diarrhea
-nausea -vomiting -loss of appetite -controled with compazine and lomotil |
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Due to large volume of bone marrow irradiated in ovarian ca ____ is seen
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luecopenia
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Late effects of abd irradiation
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bowel damage (fistulas), repaired with surgery
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Prognosis ovarian ca
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5yr/ 30%
Stage I 5yr/70% Stage IV 5yr/ 4% |
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Edema of the abd, "jelly-belly". Classic sign of ovarian ca
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ascites
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Done to check for residual or recurrent disease. Done approx. one year after tx
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"second-look" operation
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no pregnancies
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nulliparity
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seeding
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transcoelomic
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low white blood cell count
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leukopenia
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middle layer of the uterus
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myometrium
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used for endometrial cancer I-III
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Broder's grading
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Heyman's capsules
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Stockhom packing
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Drug given to prevent miscarriage- later associated with clear cell ca in daughters of these women
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DES
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inflammation of fallopian tube
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salpingitis
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