Term
| what percent of torsion in adolescents do not involve an ovarian mass |
|
Definition
|
|
Term
| what percent of torsion is not identified on laparoscopy |
|
Definition
|
|
Term
| what size pelvic mass increases the risk of torsion |
|
Definition
|
|
Term
| what are the 2 pelvic masses that cause torsion in adolescents |
|
Definition
| simple cyst, benign teratomas |
|
|
Term
| what side has more torsion and why |
|
Definition
| 64% on right side, left is protected by colon |
|
|
Term
| symptoms of torsion and incidence (3) |
|
Definition
| pain 88%, nausea 62%, vomiting 67% |
|
|
Term
| signs of torsion on ultrasound (7) |
|
Definition
| enlarge edema ovary, echogenic stroma, free fluid, whirlpool sign, asymmetric ovaries x12, multiple peripherial follicles, decreased flow (60% have flow) |
|
|
Term
| signs of torsion on CR (4) |
|
Definition
| asymmetric ovaries, uterine deviation towards pathologic side, free fluid, fat stranding |
|
|
Term
| signs of torsion on MRI (4) |
|
Definition
| decreased enhancement with contrast, asymmetric ovaries, deviation of uterus toward pathologic side, multiple peripherial follicles |
|
|
Term
| risk factors for torsion (4) |
|
Definition
| ovarian mass, congenitally long ovarian ligaments, laxity of pelvic ligaments, small uterus |
|
|
Term
| what percent of toarsed ovaries will heal and be fine |
|
Definition
|
|
Term
| when should you oopexy a torsed ovary |
|
Definition
| recurrent torsion, absent contralateral ovary, generally insufficient evidence |
|
|
Term
| what are general concepts when doing laparoscopy in adolescents |
|
Definition
use lower pressures
higher risk of injury on entry
dont do cystectomy may compormise ovary
close all fascia even 5mm
opiates <3d post op |
|
|
Term
| when pressures should be used in adolescent laparoscopy |
|
Definition
| 20kg+ start with 12 with 3-6L flow, <20kg use lower pressures |
|
|
Term
| if you dont do a cystectomy in an adolescent what is the follow up |
|
Definition
|
|
Term
| what percent of torsion is associated with malignancy |
|
Definition
| 0.4-5%, dont do oophorectomy for this, malignant stuff is usually stuck and does not toarse |
|
|
Term
| what is the recurrence rate for torsion |
|
Definition
| 2-12%, higher if toarsed spontaenously without mass |
|
|
Term
| what is the incidence of adnexal masses in general for PMP women |
|
Definition
|
|
Term
|
Definition
| <35 PMP, <200 pre-menopause |
|
|
Term
| how can you determine if CA125 is of GYN origin or GI origin |
|
Definition
| CA125:CEA 25:1 likley GYN |
|
|
Term
| what percent of ovarian cancer has an elevated CA125 |
|
Definition
| 80% of epithelial, but only 50% of all stage 1 disease patients, rarley elevated in germ cell, stromal, serous |
|
|
Term
| what benign things can cause CA125 elevations |
|
Definition
| endometriosis, pregnancy, PID, non-GYN cancer, fibroids, SLE, IBD, uterine horns non communicating, ovarian fibroma, torsions peritonitis, cirrhosis |
|
|
Term
| what are the parts of a multivariate index assay (6) |
|
Definition
| CA125, prealbumin, apolipoprotein A1, B2-microglobulin, transferrin, menopausal status |
|
|
Term
| why do we do a multivariate index assay |
|
Definition
| it is positive in 70% of malignancies when CA125 alone was negative, perdicts malignancies in 91% of cases compared to 65% CA125 alone |
|
|
Term
| what is better a multivariate index assay or ROMA |
|
Definition
| ROMA 83% vs 55% more specific, 93% of ovarian cancers were correctly called high risk before surgery |
|
|
Term
| what are the parts of OVA-1 (5) |
|
Definition
| CA125, transferrin, prealbumin, apolipoprotein A1, B2-microglobulin |
|
|
Term
| how is OVA-1 scored abnormal |
|
Definition
pre-menopause >5
post-menopause >4.4 |
|
|
Term
| what are the symptoms of ovarian cancer |
|
Definition
| fixed, irregular, nodular, firm, ascites, bloating, urinary symptoms, difficulty eating, early satiety, pelvic pain, abdominal swelling |
|
|
Term
| what are the signs of ovarian cancer on ultrasound |
|
Definition
| >10cm, solid components, papillary components, irregularity, ascites, flow (15%), thick walls, septations (worse >2-3mm), mural nodularity, bilaterality |
|
|
Term
| what is the worst sign of ovarian cancer on ultrasound |
|
Definition
|
|
Term
| what do papillary projections on ultrasound indicate |
|
Definition
| borderline until proven otherwise |
|
|
Term
| how long can you monitor a mass with solid components on US |
|
Definition
|
|
Term
| how long can you monitor a mass without solid components on ultrasound |
|
Definition
|
|
Term
| all malignancies demonstrated growth by ___ on US |
|
Definition
|
|
Term
| what is the #1 adolescent ovarian malignancy |
|
Definition
|
|
Term
| 3 ovarian masses in pregnancy and their incidence |
|
Definition
| corpus luteum 17%, demoid 37%, cancer 1-7%, borderline 1-2% |
|
|
Term
| what is the rate of torsion for ovarian masses in pregnancy |
|
Definition
|
|
Term
| how are ovarian masses in pregnancy managed |
|
Definition
US in 4-6wk to see if resolution or progression, delay until PP unless concern for malignancy or torsion
if found during CD then resect and send for frozen if malignancy concern |
|
|
Term
|
Definition
| low level echoes, round, homogenous |
|
|
Term
|
Definition
| tubular, sonolucent, cyst |
|
|
Term
|
Definition
| smooth walls, thin, no flow |
|
|
Term
| when should a simple cyst be resected |
|
Definition
|
|
Term
| how long should you observe an unchanging simple cyst |
|
Definition
|
|
Term
| why dont we aspirate simple cysts |
|
Definition
| 44% recurrence pre-menopause, 25% recurrence post-menopause |
|
|
Term
| ovarian cancer is the #__ cause of death in women |
|
Definition
|
|
Term
| what is the general population risk of ovarian cacer |
|
Definition
|
|
Term
| what percent of ovarian cancer present at stage 3+ |
|
Definition
|
|
Term
| when do you do LND in ovarian cancer surgery |
|
Definition
| no ovbious metastasis, debulking |
|
|
Term
| suboptimal cytoreduction is associated with a CA125 level |
|
Definition
|
|
Term
| what is the goldie coldman hypothesis |
|
Definition
| resistance of chemotherapy will develop in fraction to remaining viable cells |
|
|
Term
| how much does optimal cytoreduction improve survival |
|
Definition
| in stage 4 disease increases survival from 30 to 64mo |
|
|
Term
| how often does optimal cytoreduction require bowel resection |
|
Definition
|
|
Term
| how often and what complications can occur form bowel resection |
|
Definition
| 5%, infection, anastamotic breakdown, fistula |
|
|
Term
| how is ovarian cancer staged 1-2 |
|
Definition
1A - one ovary, capsule intact
1B - 2 ovary, capsule intact
1C1 - surgical spill
1C2 - capsule rupture before surgery
1C3 - malignancy in washings
2A - uterus/tubes or primary peritoneal
2B - other pelvic tissues |
|
|
Term
| how is ovarian cancer staged 4 |
|
Definition
A - pleural effusion with positive cytology
B - liver, spleen, inguinal nodes, nodes outside abodmen, distant mets |
|
|
Term
| what are the basic concepts of stage 3 staging for ovarian cancer |
|
Definition
primary peritoneals included
positive nodes
mets outside pelvic brim but in abdomen not involving liver/spleen |
|
|
Term
| what is the chemotherapy used for ovarian cancer |
|
Definition
|
|
Term
| what is the surveillence after ovarian cancer treatment |
|
Definition
exam q2-3mo for 2y then q3-6mo for 3y, then annual x5y
CA125 if previously elevated
imaging if clinical symptoms |
|
|
Term
| what is the survival rate for stage 1 ovarian cancer for fertility and non fertility sparing |
|
Definition
| 90-95% does not change if fertility sparing |
|
|
Term
| what stages of ovarian cancer could be observed, no chemo |
|
Definition
| stage 1A grade 2, stage 1B grade 2 |
|
|
Term
| at what stage can you no longer consider fertility sparing management for ovarian cancer |
|
Definition
|
|
Term
| what is the 5y survival for stage 2, 3, 4 ovarian cancer |
|
Definition
2 - 70%
3A - 40%
3B - 25%
3C - 20%
4 - 11% |
|
|
Term
| what are some options for prevention in patients for remission from ovarian cancer |
|
Definition
|
|
Term
| what is better neoadjuvant chemo or optimal debulking |
|
Definition
| optimal debulking, if you dont think you can achieve do neoadjuvant |
|
|
Term
| when should IP chemo be done |
|
Definition
| optimal debulked patients |
|
|
Term
| what are complications of IP chemo |
|
Definition
| increased pain, all the normal SE of the chemo, catheter issues #1 cause of DC (infection, leaking, blockage, access issues) |
|
|
Term
| what increases the risk of IP cath complications and how can this be reduced |
|
Definition
| left colon resection, can reduce by delaying placement until 1-2C of therapy complete to reduce risk |
|
|
Term
| what is better IV or IP chemo |
|
Definition
| IP improves survival per GOG |
|
|
Term
| define platinum sensitive vs resistant vs refractory |
|
Definition
sensitive - recurrence >6mo after platinum therapy
resistant - recurrence <6mo
refractory - progression during initial therapy |
|
|
Term
| what do you use for chemo in a platinum resistant patient |
|
Definition
| IV cystplatin with doxyrubicin or gemcitabine |
|
|
Term
| what percent of ovarian cancer is a mets from another cancer and what are the common types (3) |
|
Definition
10%
1- endometrial
2- colon
3- breast |
|
|
Term
| what is the name for bilateral ovarian masses caused by metastatic gastric cancer |
|
Definition
|
|
Term
| what are the types of ovarian tumors and their incidence (4) |
|
Definition
epithelial - 90%
metastasis - 10%
germ cell
sex cord stroma - 1% |
|
|
Term
| what are the types of benign epithelial ovarian tumors (6) |
|
Definition
serous
mucinous
endometrotic
clear cell
brenner
seromucinous
all can be adenoma, adenofibroma |
|
|
Term
| what are the types of malignant epithelial ovarian tumors (11) |
|
Definition
borderline - 15%
endometroid -
serous - high and low grade
clear cell - 5%
mucinous - 15%
brenner
seromucinous
undifferentiated
mesenchumal
adenosarcoma
carcinosarcoma |
|
|
Term
| risk factors for ovarian cancer (7) |
|
Definition
| age, genetic, nulliparity, infertility (not the drugs), endometriosis, PCOS, enviromental |
|
|
Term
| protective factors for ovarian cancer (7) |
|
Definition
| parity, OCPs, breastfeeding, salpingectomy 0.7%, hysterectomy, oophorectomy, pregnancy before 25yo |
|
|
Term
| how much do OCPs decrease risk of ovarian cancer |
|
Definition
|
|
Term
| how much does salpingectomy decrease risk of ovarian cancer |
|
Definition
|
|
Term
| how much does oophorectomy decrease risk of ovarian cancer |
|
Definition
|
|
Term
| average age of borderline ovarian tumor |
|
Definition
|
|
Term
| histology of borderline ovarian tumor (5) |
|
Definition
| nuclear atypia, epithelial stratification, papillary tufting, no stromal invasion, micropapillae |
|
|
Term
| when a borderline tumor has micropapillae what does this increase the risk of (2) |
|
Definition
| bilaterality, invasive implants, does not change survival |
|
|
Term
| what is the #1 and 2 varient of borderline ovarian tumors |
|
Definition
1 - serous aka atypical proliferative serous tumor
2- endometroid aka atypical proliferative endometroid tumor |
|
|
Term
| how is a borderline tumor managed |
|
Definition
USO if fertility sparing, TLH/BSO if not, omentectomy (upstages 30% of patients), no LND
if invasive implants treat as low grade serous, adjuvant chemo only if in omentum |
|
|
Term
| what is the surveillence after borderline tumor |
|
Definition
exam q3-6mo for 5y then annually
CA125 if initially elevated
imaging as indicated |
|
|
Term
| what is the recurrence rate for borderline ovarian tumor |
|
Definition
50%, 75% being low grade serous
x6 if did cystectomy rather than oophorectomy
x5 if gross residual disease after surgery |
|
|
Term
| what are the tumor markers for low grade serous tumors (7) |
|
Definition
| KRT7, CK7, BRAF/KRAS 85%, CA125, PAX8, WT1 |
|
|
Term
| histology of low grade serous tumors (4) |
|
Definition
| oval/round nuclei, uncommon nucleoli, <12 mitotic figures per 10 HPF, stromal invasion |
|
|
Term
| management of low grade serous tumors |
|
Definition
TLH/BSO/omentum/debul
1 - observe
1C - +/- chemo +/- AIs
2+ chemo + AIs |
|
|
Term
| what mutation has the best prognosis for serous low grade |
|
Definition
|
|
Term
| what is the rate of resistant low grade serous tumors to chemo |
|
Definition
|
|
Term
| what are the mutations associated with high grade serous tumors (2) |
|
Definition
|
|
Term
| what are the mutations associated with high grade clear cell tumors (8) |
|
Definition
loss of ARIDA1 in 50%
loss of BRAF250
upregular of SICA2 and CCL14
downregulation of TGDF1
PTEN
KRAS
MMR |
|
|
Term
| risk factors for clear cell tumors |
|
Definition
| asian x2, endometriosis 50% (27% increased risk), endometriosis surgery |
|
|
Term
| management of clear cell tumors |
|
Definition
| everyone gets chemo after surgery |
|
|
Term
| what is pseudomyxoma peritoneii |
|
Definition
| rupture of mucinous tumor |
|
|
Term
| what mutations are associated with mucinous tumors (2) |
|
Definition
CK20, KRT20, CEA, CDX2
CEA/CK20 more indicative of GI primary
PAX5 more indicative of ovarian primary |
|
|
Term
| what is the average age of mucinous tumors |
|
Definition
|
|
Term
| what percent of mucinous tumors are bilateral, if not what side are they on |
|
Definition
|
|
Term
| how are mucinous tumors managed |
|
Definition
1 - observe after surgery
1C - +/- chemo
2+ chemo |
|
|
Term
| average age germ cell tumors |
|
Definition
|
|
Term
| what percent of germ cell tumors are stage 1 at diagnosis |
|
Definition
|
|
Term
| signs of germ cell tumors (4) |
|
Definition
| unilateral, rapid enlargement, pain, hemoperitoneum |
|
|
Term
| survival rate for completely resected germ cell tumor |
|
Definition
|
|
Term
| types of germ cell tumors (9) |
|
Definition
dysgerminoma
endometrial sinus - yolk sac
mature teratoma - dermoid - benign
immature teratoma
strumi ovarii - benign
sebaceous adenoma - benign
stromal carcinoid - borderline
mucinous carcinoid - malignant
SCC - malignant |
|
|
Term
| #1 malignant germ cell tumor |
|
Definition
|
|
Term
| what percent of dysgermanoma are bilateral |
|
Definition
|
|
Term
| risk factor for dysgermanoma |
|
Definition
|
|
Term
| serum markers for dysgermanoma |
|
Definition
| low hCG, LDH isoenzymes 1, 2, 3 |
|
|
Term
|
Definition
| large vesicular walls, clear cytoplasm, |
|
|
Term
| percent of dysgermanoma with nodal spread |
|
Definition
|
|
Term
| management of dysgermanoma |
|
Definition
| USO, no staging indicated, chemo rads sensitive, if stage 1 observe, if > stage 1 chemo BEP |
|
|
Term
|
Definition
|
|
Term
| varients yolk sac tumor (3) |
|
Definition
| polyvesicular vitelline, glandular, hepatoid |
|
|
Term
| management yolk sac tumor |
|
Definition
| USO, all require chemo BEP |
|
|
Term
|
Definition
| 15% BL, 20-45% of ovarian neoplasms |
|
|
Term
|
Definition
| dermoid with monodermal thyroid tissue that an cause hyperthyroidism |
|
|
Term
| what percent of dermoids have malignancy and what is it |
|
Definition
|
|
Term
| what percent of people with a dermoid that do expectant management will end of getting surgery |
|
Definition
|
|
Term
| how do immature teratomas spread |
|
Definition
|
|
Term
| serum markers immature teratoma (3) |
|
Definition
|
|
Term
| management immature teratoma |
|
Definition
| USO, stage 1 grade 1 observe, everyone else gets BEP |
|
|
Term
|
Definition
| bleomycin, etoposide, cisplatin 3-4C |
|
|
Term
| what is the surveillence after germ cell tumors |
|
Definition
exam and AFP q2-3mo for 1y -> q4mo 1y -> q6mo 3y -> annually
CT A/P q3-4mo 1y -> q6mo 1y -> annually 3y -> as indicated
if non-dysgernaoma do CXR with CT |
|
|
Term
| what are the benign sex cord stromal tumors (5) |
|
Definition
thecoma
fibroma
leydig cell
stromal
lutenized thecoma |
|
|
Term
| what are the borderline sex cord stromal tumors (5) |
|
Definition
cellular fibroma
gonadoblastoma
mixed germ cell
sertoli cell
sex cord with annular tubules |
|
|
Term
| what is a leutenized thecoma associated with |
|
Definition
|
|
Term
|
Definition
| ovarin fibroma causing ascites and hydrothorax |
|
|
Term
| what is the average age of fibroma and thecoma |
|
Definition
|
|
Term
| what are the malignant germ cell tumors (4) |
|
Definition
fibrosarcoma
steroid cell tumor
granulosa cell
sertoli-leydig |
|
|
Term
| types of granulosa cell tumors and their incidence |
|
Definition
|
|
Term
| histology adult granulosa cell tumors |
|
Definition
| call exner bodies, cords, trabeculae, round cells, scant cytoplasm,, coffee-bean grooved nuclei |
|
|
Term
| histology juvenile granulosa cell tumors |
|
Definition
| solid, focal follicles, more cytoplasm than adult, round nuclei, hyperhcromatic, brisker mitotic activity, sometimes marked atypia |
|
|
Term
| serum markers granulosa cell tumor |
|
Definition
|
|
Term
| signs granulosa cell tumor |
|
Definition
| endometrial pathology (25-50% hyperplasia), precocious puberty, large mass (mean 12cm), friable mass |
|
|
Term
| management granulosa cell tumor |
|
Definition
USO, no LND
1 - consider chemo if high risk (poor differentiated, 1C, heterologous elements, ruptured)
>1 - platinum chemo |
|
|
Term
| prognosis granulosa cell tumor 1A and 1A+ |
|
Definition
1A - 95% survival 5y
>1A - 55% survival
juvenile better survival
larger tumor less favorable >10cm or ruptured |
|
|
Term
| signs of sertoli leydig tumor |
|
Definition
|
|
Term
| serum markers sertoli leydig tumor |
|
Definition
|
|
Term
| prognosis sertoli leydig tumor |
|
Definition
|
|
Term
| management sertoli leydig tumor |
|
Definition
USO, no LND
1 - consider chemo if high risk (poor differentiated, 1C, heterologous elements, ruptured)
>1 - platinum chemo |
|
|
Term
| potential complications of oopexy - 1 |
|
Definition
| interference with blood supply or function |
|
|
Term
| what can be used in patients with frequent torsion for prevention |
|
Definition
|
|
Term
| what are the parts of a ROMA score - 3 |
|
Definition
|
|
Term
| % of time ascites is associated with cancer |
|
Definition
|
|
Term
| #1 cancer associated with ascites |
|
Definition
|
|
Term
| how is ascites related to prognosis of cancer |
|
Definition
|
|
Term
| what drug can help with ascites |
|
Definition
|
|
Term
| #1 concerning sign in cancer |
|
Definition
|
|
Term
| when to refer to a GYN ONC - 4 |
|
Definition
1. PMP with elevated CA125 US suggestive of malignancy.
2. Pre-MP with CA125 >200 and US suggestive of malignancy.
3. Pre-MP or PMP with elevated risk assessment
4. family history of breast or ovarian cancer in a 1st deg relative with a suspicious mass |
|
|
Term
| rate of ovarian masses in pregnancy |
|
Definition
|
|
Term
| why don't we use gadolinium in pregnancy - 5 |
|
Definition
| increases fetal rheumatologic, inflammatory, and infiltrative skin conditions, still birth, neonatal death |
|
|
Term
| % of complex masses in pregnancy that are malignant |
|
Definition
|
|
Term
| management of cystic teratoma in pregnancy |
|
Definition
| removal in 2T is optional, unilateral lymphadenectomy |
|
|
Term
| if a malignancy is found on an incidental mass at CD when do you do the staging |
|
Definition
|
|
Term
| 2 predictors that an ovarian mass in pregnancy might not resolve |
|
Definition
|
|
Term
| ovarian cancer is the #__ GYN cancer and the #__ most deadly GYN cancer |
|
Definition
|
|
Term
| boundries for paraaortic node dissection |
|
Definition
| over the IVC/aorta between the renal and inferior mesenteric vessels |
|
|
Term
| boundries for pelvic node dissection 4 |
|
Definition
| common iliac, external iliac, hypogastric, obturator nerve and fossa |
|
|
Term
| how do you treat a platinum sensitive recurrence |
|
Definition
| carboplatin until 2C past complete remission |
|
|
Term
| rate and timing of ovarian cancer relapse |
|
Definition
|
|
Term
| in a patient who is a poor surgical candidate how do you treat them |
|
Definition
| neoadjuvant chemo, if at the end they progressed they treat as platinum resistant, if they are stable or responded consider interval cytoreduction |
|
|
Term
| where does ovarian cancer metastasize |
|
Definition
| stomach, mesenteric nodes, bladder, bowel |
|
|
Term
| what do you do if a borderline tumor is not completely resectable |
|
Definition
| CT scan for residual disease, if none observe, if residual treat like low grade epithelial |
|
|
Term
| invasive mets in border line tumor increase the risk of - 2 |
|
Definition
|
|
Term
| what injury during surgery for borderline tumor increases risk of recurrence |
|
Definition
|
|
Term
| what epithelial ovarian tumors are candidates for hormonal management in stages 1C+ - 2 |
|
Definition
| endometroid, low grade serous |
|
|
Term
| in what 2 epithelial ovarian cancers can you fertility spare |
|
Definition
| borderline, low grade mucinous, potentially endometroid? |
|
|
Term
| low grade serous chemo response rate |
|
Definition
|
|
Term
| what medical complication does pseudomyexoma peritonei increase the risk of |
|
Definition
|
|
Term
| #2 malignant germ cell tumor |
|
Definition
|
|
Term
| 2 ovarian tumors that get largest up to 30cm |
|
Definition
| mucinous, endodermal sinus |
|
|
Term
| #1 most common germ cell tumor |
|
Definition
|
|
Term
| how is immature teratoma graded |
|
Definition
|
|
Term
| what do you do if a germ cell tumor is persistent after BEP or there is an incomplete or no response |
|
Definition
| TIP - paclitaxel, isofosfamide, cisplatin |
|
|
Term
| what do you do if a dysgerminoma recurs/does not respond |
|
Definition
| radiotherapy - ONLY RADIOSENSITIVE OVARIAN TUMOR |
|
|
Term
| what tumor gets meigs syndrome |
|
Definition
|
|
Term
| how are seroli Leydig tumors managed |
|
Definition
| TAH/BSO/staging - if stage 1 observe, if Ic/ruptured/poor differentiation/heterologous elements do chemo, if 2+ do chemo |
|
|
Term
| what stages of Sertoli Leydig can do fertility sparing |
|
Definition
|
|
Term
| what is a sign that a Sertoli Leydig tumor is more aggressive - 2 |
|
Definition
| heterologous elements, endocrine changes |
|
|
