Term
| *check the objectives - he wrote them after writing the exam questions* |
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Definition
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Term
| what is the most common type of CA in the ovary? |
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Definition
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Term
| what is the surface of the epithelium of the ovary more aptly described as? |
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Definition
| mesothelium - b/c it is contiguous with the *peritoneal lining of the abdomen |
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Term
| what are the different possible types of epithelial ovarian CA? |
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Definition
| papillary serous (most common), endometrioid, mucinous, clear cell, and squamous cell (rare) |
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Term
| what determines the risk of recurrence and survival in ovarian CA? |
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Definition
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Term
| what is the 2nd most common GYN malignancy? |
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Definition
| ovarian (first is uterine) |
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Term
| *what is the most lethal GYN malignancy? (exam question)* |
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Definition
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Term
| how does the risk of ovarian CA correlate w/age? |
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Definition
| risk of ovarian CA increases w/age |
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Term
| what is the increased risk for ovarian CA in a pt with a BRCA1/2 mutation? |
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Definition
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Term
| what are the risk factors for ovarian CA? |
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Definition
| *BRCA1/2 mutation, *fam hx of ovarian CA, older age, infertility, nulligravidity, endometriosis, higher socioeconomic status, and early menarche/late menopause (more ovulations per lifetime) |
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Term
| can prior hysterectomy/BTL or OCP use decrease risk of ovarian CA? |
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Definition
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Term
| what are the genetic associations w/ovarian CA? |
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Definition
| the majority of ovarian CA (85%) is due to sporadic mutation, 13% is due to BRCA1/2 mutation, and 2% is due to HNPCC (mismatched repair gene). therefore - only 15% is known to be hereditary. |
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Term
| *is the pathogenesis of ovarian CA known? (exam question)* |
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Definition
| *no, there are only theories* |
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Term
| what is the repeated ovulation/trauma to ovarian surface epithelium theory of ovarian CA pathogenesis? |
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Definition
| the repeated bursting of the mature follicle through the epithelium to get to the fallopian tube causes enough local trauma/inflammatory response enough times that it gets to the point of collecting errors and mutations that lead to carcinogenesis. |
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Term
| what is the hormonal imbalance theory of ovarian CA pathogenesis? |
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Definition
| hypergonadotropin release/hormonal imbalance/obesity can lead to increased estrogen, leading to increased epithelial proliferation which carries the constant pressure to undergo mitosis/cell division enough times that errors and mutations collect and cancer appears. |
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Term
| what is the fallopian tube theory of ovarian CA pathogenesis? |
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Definition
| that serous ovarian cancer comes from the fallopian tube (not the ovary). CA of the ovary, fallopian tube, and peritoneum are histologically, genetically, and clinically similar - and men don't get primary peritoneal CA. |
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Term
| what stage to most pts w/ovarian CA present? |
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Definition
| 75% present in advanced stage |
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Term
| is there a current effective ovarian CA screening process? |
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Definition
| no, what is available is US (not proven) and CA-125 (most common tumor marker in ovarian CA - not sensitive). |
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Term
| what are some possible presenting symptoms of an ovarian CA pt? |
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Definition
| vague abdominal cramps, bloating, anorexia, increased SOB w/exercise, and constant thirst |
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Term
| is there a correlation between breast CA hx and ovarian CA risk? |
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Definition
| yes, and a family hx of breast CA is also a risk factor for ovarian CA |
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Term
| what is an important part of the gynecological workup? |
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Definition
| recto-vaginal exam (can feel pelvic masses better) |
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Term
| can ovarian CA push all the small bowel up into the LUQ? |
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Definition
| yes, this would be visible on CT |
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Term
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Definition
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Term
| what are the 2 management options for ovarian CA? |
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Definition
| 1) sx to remove/dx, then chemo. 2) a little chemo, then sx, then a little more chemo (neoadjuvant). both have shown equal outcomes at this point. |
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Term
| how is sx for ovarian CA carried out? |
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Definition
| midline laparotomy, collect any fluid/washing, explore entire abdomen, then hysterectomy and BSO (bilateral salpingo-oophorectomy), then "debulking" - physically removing all tumor and omental cake. |
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Term
| *what is the most important surgical goal in ovarian CA tx? (exam question)* |
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Definition
| *removal of all visible disease* (each 10% increase in surgical clearance equals 5% increase in survival) |
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Term
| what is staging for ovarian CA? |
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Definition
| stage I (confined to one or both ovaries), stage II (spread to other pelvic organs), stage III (spread to upper abdomen/lymph nodes), stage IV (distant spread i.e. lungs) |
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Term
| what are the 2 main chemotherapeutic agents used in ovarian CA tx? |
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Definition
| platinum compounds and taxanes |
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Term
| what characterizes the platinum compound chemotherapeutic agents used in ovarian CA tx? |
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Definition
| the platinum compounds alkylate DNA, crosslink bases (halt mitosis) and can cause neuro- and renal toxicity. examples: *carboplatin* (preferred b/c of less renal toxicity, but has bone marrow suppression) and cisplatin. |
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Term
| what characterizes the taxane chemotherapeutic agents used in ovarian CA tx? |
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Definition
| the taxanes are plant derived, and stabilize microtubules (so can’t disassemble at end of mitosis), which arrests mitosis. they can cause neurotoxicity and alopecia. examples: *paclitaxel* (more alopecia and neurotoxicity) and docetaxel. |
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Term
| what is the standard chemo tx administered for ovarian CA? (maybe exam question) |
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Definition
| *carboplatin-paclitaxel* (aka taxol/carbo) which is given IV or IP (intraperitoneally) or both |
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Term
| what is the 5 year overall survival rate for ovarian CA? (*exam question*) |
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Definition
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Term
| can anti-VEGF therapy such as bevacizumab, a humanized monoclonal antibody help w/ovarian CA? ADRs? |
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Definition
| probably, one study showed a 29% reduction in risk of progression in ovarian CA. ADRs: HTN and risk of bowel perforation/fistula. |
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