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12 Cards in this Set
- Front
- Back
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What is the estimated 5-year survival rate for patients w/ ovarian cancer (all-comers)?
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38%
- no significant change over several decades despite advances in care - median survival has improved |
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Approximately what proportion of pts w/ ovarian cancer are initially managed by gynaecologic oncologists?
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- 1/3 only
- initial surgery more likely to be appropriately staged and optimally debulked if performed by gyne onc |
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What symptoms on history are more suggestive of underlying ovarian malignancy?
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- pelvic/abdominal pain
- urinary urgency/frequency - increased abdominal size/bloating - difficulty in eating/early satiety especially if persistent symptoms (present x < 1 year and occurring > 12 days/month) |
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What family history should be elicited in evaluating a pelvic mass?
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- significant family history of neoplasia in:
- breast - ovarian - endometrial - colorectal - pancreatic |
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What ultrasonographic features increase the risk of malignancy?
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- complex
- multilocular - thick septations - presence of papillary excrescences - solid components - increased central vascularity - evidence of ascites - evidence of peritoneal nodularities |
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What is the normal cutoff for serum CA125 level?
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35 U/mL
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What is the cutoff for risk of malignancy index (RMI) score?
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200
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Which is better, RMI I or RMI II?
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RMI II is superior
- more sensitive - specificity = 89-92% - PPV = ~80% |
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Describe the RMI II scoring system
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- CA125 level in U/mL
- pre-menopausal = 1, post-menopausal = 4 - no or one abnormality on U/S = 1, two or more abnormalities on U/S = 4 U/S abnormalities include: - multilocular cyst - presence of solid areas - bilaterality of lesions - presence of ascites - presence of intra-abdominal metastasis U/S features x menopausal status x CA125 cutoff = 200 eg. post-menopausal woman w/ multilocular cyst with solid areas and ascites, CA125 = 100, RMI II score = 4x4x100 =1600 |
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How often are patients thought to have disease clinically confined to ovaries are upstaged upon more comprehensive surgical staging?
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30%
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What does comprehensive surgical staging for ovarian cancer include?
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1. total hysterectomy and BSO in post-menopausal women; fertility preservation is acceptable if desired
2. infracolic omentectomy 3. peritoneal fluid sampling or pelvic washings 4. biopsy of any suspicious peritoneal nodules/adhesions or random biopsies from all intra-abdominal serosal surfaces 5. bilateral diaphragmatic scraping/biopsies 6. bilateral pelvic LNs and para-aortic LNs |
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What are the benefits of initial surgical management by gyne oncology?
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- for early-stage disease:
- lower recurrence rates - improved overall survival (24% improvement in 5-year survival) - for advanced-stage disease: - improved rate of optimal debulking - improved overall survival - 6-9 month increase in median survival |
