Ovarian Cancer May 2007 Dr Anna Winship Guy’s & St. Thomas’ NHS Trust Click Here For First Question Oncology Registrars’ Forum “Best of Five”

Ovarian Cancer

May 2007Dr Anna Winship

Guy’s & St. Thomas’ NHS Trust

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Oncology Registrars’ Forum

“Best of Five”

Question 1• A 66 year old women underwent a staging laparotomy, TAH, BSO

and omentectomy for ovarian cancer. What is the most likely diagnosis?

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Serous cystadenocarcinoma

Endometrioid adenocarcinoma

Mucinous cystadenocarcinoma

Clear cell cystadenocarcinoma

Transitional cell carcinoma


and omentectomy for ovarian cancer. What is the most likely diagnosis?

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Serous cystadenocarcinoma

Endometrioid adenocarcinoma

Mucinous cystadenocarcinoma

Clear cell cystadenocarcinoma

Transitional cell carcinoma


and omentectomy for ovarian cancer. What is the most important risk factor for the development of ovarian cancer?


Infertility

Oestrogen replacement therapy

Diet / obesity

Family history

Talcum powder (perineal application)


and omentectomy for ovarian cancer. What is the most important risk factor for the development of ovarian cancer?


Infertility

Oestrogen replacement therapy

Diet / obesity

Family history

Talcum powder (perineal application)

Question 3• A 35 year old women complained of right sided pelvic pain and was

found to have an adnexal mass. Her risk of malignancy index (RMI) was calculated. What is the correct formula?

U = Ultrasound results; M = menopausal status


U x age x M x Ca125

U x M x age

U x M x Ca125

M x age x Ca125

U x age x Ca125


found to have an adnexal mass. Her risk of malignancy index (RMI) was calculated. What is the correct formula?

U = Ultrasound results; M = menopausal status


U x age x M x Ca125

U x M x age

U x M x Ca125

M x age x Ca125

U x age x Ca125


found to have an adnexal mass. Her RMI was calculated at 225. Which investigation (if any) should be performed next?


No further investigation

Fine needle aspirate of adnexal mass

Trucut biopsy of adnexal mass

CT scan of abdomen / pelvis

Staging laparotomy


found to have an adnexal mass. Her RMI was calculated at 225. Which investigation (if any) should be performed next?


No further investigation

Fine needle aspirate of adnexal mass

Trucut biopsy of adnexal mass

CT scan of abdomen / pelvis

Staging laparotomy

Question 5• A 50 year old nurse underwent a staging laparotomy, TAH, BSO and

omentectomy for ovarian cancer. She was found to have a large right ovarian mass with cystic and solid elements, rupture of the capsule, omental deposits measuring <2cm in diameter, liver capsule deposits, a small amount of ascites and a small pleural effusion. From the information given her FIGO stage is:


Stage IV

Stage IIB

Stage IIIA

Stage IIIB

Stage IIIC

Question 5• A 50 year old nurse underwent a staging laparotomy, TAH, BSO and

omentectomy for ovarian cancer. She was found to have a large right ovarian mass with cystic and solid elements, rupture of the capsule, omental deposits measuring <2cm in diameter, liver capsule deposits, a small amount of ascites and a small pleural effusion. From the information given her FIGO stage is:


Stage IV

Stage IIB

Stage IIIA

Stage IIIB

Stage IIIC

Question 6• A 42 year old accountant underwent a staging laparotomy, TAH, BSO

and omentectomy for a poorly-differentiated serous cystadenocarcinoma. The operation note stated that “optimal” cytoreduction was obtained. The accepted definition of “optimal” encompasses patients in whom there remain no tumour nodules greater than:


1.5cm in diameter

0.2cm in diameter

0.5cm in diameter

0.7cm in diameter

1.0cm in diameter

Question 6• A 42 year old accountant underwent a staging laparotomy, TAH, BSO

and omentectomy for a poorly-differentiated serous cystadenocarcinoma. The operation note stated that “optimal” cytoreduction was obtained. The accepted definition of “optimal” encompasses patients in whom there remain no tumour nodules greater than:


1.5cm in diameter

0.2cm in diameter

0.5cm in diameter

0.7cm in diameter

1.0cm in diameter

Question 7• A 63 year old civil servant underwent a staging laparotomy, TAH,

BSO and omentectomy and was found to have a stage IIC mucinous cystadenocarcinoma of the ovary. She was offered adjuvant chemotherapy. Which drug or drug-combination is most likely to cause peripheral neuropathy?


Cisplatin / pactitaxel

Single agent carboplatin

Carboplatin / paclitaxel

Carboplatin / docetaxel

Cisplatin / docetaxel

Question 7• A 63 year old civil servant underwent a staging laparotomy, TAH,

BSO and omentectomy and was found to have a stage IIC mucinous cystadenocarcinoma of the ovary. She was offered adjuvant chemotherapy. Which drug or drug-combination is most likely to cause peripheral neuropathy?


Cisplatin / pactitaxel

Single agent carboplatin

Carboplatin / paclitaxel

Carboplatin / docetaxel

Cisplatin / docetaxel

Question 8• A 48 year old teacher underwent a staging laparotomy, TAH, BSO

and omentectomy for suspected ovarian cancer. A large right ovarian mass with solid and cystic elements was found. Histopathology showed a clear cell carcinoma of the right ovary with a small focus of disease in the left ovary. What is the most appropriate management?


Adjuvant chemotherapy with 8 cycles of carboplatin / paclitaxel

Observation with serial Ca125

Adjuvant chemotherapy with 6 cycles of carboplatin



Question 8• A 48 year old teacher underwent a staging laparotomy, TAH, BSO

and omentectomy for suspected ovarian cancer. A large right ovarian mass with solid and cystic elements was found. Histopathology showed a clear cell carcinoma of the right ovary with a small focus of disease in the left ovary. What is the most appropriate management?







Question 9• A 40 year old woman underwent a staging laparotomy, TAH, BSO

and omentectomy for stage IIIB clear cell carcinoma of the ovary. What is the most appropriate management?








and omentectomy for stage IIIB clear cell carcinoma of the ovary. What is the most appropriate management?







Question 10• A 40 year old woman receives chemotherapy for stage IIIB clear cell

carcinoma of the ovary. 6 weeks following completion of ther treatment a CT scan shows no evidence of residual disease. She remains well for 9 months but her Ca125 rises from 19 to 65. She is asymptomatic. What is the most appropriate management?


Repeat Ca125 in 8 weeks

Repeat Ca125 in 6 months

Repeat CT scan

Chemotherapy with carboplatin / paclitaxel

Chemotherapy with single agent carboplatin


carcinoma of the ovary. 6 weeks following completion of ther treatment a CT scan shows no evidence of residual disease. She remains well for 9 months but her Ca125 rises from 19 to 65. She is asymptomatic. What is the most appropriate management?


Repeat Ca125 in 8 weeks

Repeat Ca125 in 6 months

Repeat CT scan

Chemotherapy with carboplatin / paclitaxel

Chemotherapy with single agent carboplatin


and omentectomy for stage IIIB clear cell carcinoma of the ovary. Which trial(s) may she be eligible for?


ICON4

ICON5

ICON4, SCOTROC4

ICON5, SCOTROC4

ICON4, ICON5, SCOTROC4


and omentectomy for stage IIIB clear cell carcinoma of the ovary. Which trial(s) may she be eligible for?


ICON4

ICON5

ICON4, SCOTROC4

ICON5, SCOTROC4

ICON4, ICON5, SCOTROC4


and omentectomy for suspected ovarian cancer. Which FIGO stage is she most likely to have?


I then II then III then IV

II then III then I then IV

III then IV then I then II

III then I then IV then II

IV then III then I then II


and omentectomy for suspected ovarian cancer. Which FIGO stage is she most likely to have?


I then II then III then IV

II then III then I then IV

III then IV then I then II

III then I then IV then II

IV then III then I then II

Question 13• A 59 year old woman underwent transvaginal ultrasound scanning

which confirmed the presence of a semi-cystic, semi-solid mass arising from the left ovary. Her Ca125 was 70. What is her RMI from the information given?


70

210

630

4130

None of the above

Question 13• A 59 year old woman underwent transvaginal ultrasound scanning

which confirmed the presence of a semi-cystic, semi-solid mass arising from the left ovary. Her Ca125 was 70. What is her RMI from the information given?


70

210

630

4130

None of the above


carcinoma of the ovary. 6 weeks following completion of ther treatment a CT scan shows no evidence of residual disease. She remains well for 9 months but her Ca125 rises from 19 to 65. She is asymptomatic. How would you define her disease?


Chemo-sensitive

Chemo-refractory

Chemo-resistant

Partially chemo-resistant

Partially chemo-sensitive


carcinoma of the ovary. 6 weeks following completion of ther treatment a CT scan shows no evidence of residual disease. She remains well for 9 months but her Ca125 rises from 19 to 65. She is asymptomatic. How would you define her disease?


Chemo-sensitive

Chemo-refractory

Chemo-resistant

Partially chemo-resistant

Partially chemo-sensitive


carcinoma of the ovary. 6 weeks following completion of ther treatment a CT scan shows no evidence of residual disease. She remains well for 9 months but her Ca125 rises from 19 to 65. She is asymptomatic. What is the most important prognostic factor?


Stage of disease

Ca125

Age

Extent of debulking surgery

Response to platinum


carcinoma of the ovary. 6 weeks following completion of ther treatment a CT scan shows no evidence of residual disease. She remains well for 9 months but her Ca125 rises from 19 to 65. She is asymptomatic. What is the most important prognostic factor?


Stage of disease

Ca125

Age

Extent of debulking surgery

Response to platinum


carcinoma of the ovary. 6 weeks following completion of ther treatment a CT scan shows no evidence of residual disease. She remains well for 9 months but her Ca125 rises from 19 to 65. She is asymptomatic. What is her overall 5-year survival rate?


10%

50%

40%

30%

20%


carcinoma of the ovary. 6 weeks following completion of ther treatment a CT scan shows no evidence of residual disease. She remains well for 9 months but her Ca125 rises from 19 to 65. She is asymptomatic. What is her overall 5-year survival rate?

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10%

50%

40%

30%

20%

The End

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Ovarian Cancer May 2007 Dr Anna Winship Guy’s & St. Thomas’ NHS Trust Click Here For First Question Oncology Registrars’ Forum “Best of Five”