Ovarian Tumors and Carcinoma Review

A comprehensive set of practice flashcards covering epidemiology, risk factors, staging, imaging, and pathology of ovarian tumors and carcinomas.

Why is ovarian carcinoma often called the 'silent killer'?

Early disease usually has no symptoms and many cases are detected at advanced stages (stage II/III).

What are common adnexal findings on physical exam in ovarian carcinoma?

Findings range from almost normal adnexa to enlarged, firm, irregular ovaries or pelvic masses.

What signs may be present in advanced ovarian cancer on examination?

Ascites and omental masses may be palpated.

What is CA-125 and what are its limitations as a screening tool?

CA-125 is a blood test that can help in assessment but has many false positives/negatives and detects only about 50% of stage III cases; not reliable for screening.

How do ovarian tumor masses typically present and what is the bilaterality percentage?

Masses can be complex, cystic, or solid; up to 20% are bilateral.

What cyst size is more suggestive of benign disease versus malignant disease?

Masses

Which genetic mutations are most strongly linked to increased ovarian cancer risk?

BRCA1 and BRCA2 (MSH2 and MLH1 less commonly).

What is the strongest risk factor for ovarian cancer?

Family history of ovarian or breast cancer.

What are common clinical symptoms of ovarian carcinoma?

Vague abdominal pain, swelling, indigestion, urinary frequency, constipation, weight changes; ascites may be present.

What does Stage I signify in ovarian cancer and what are its subcategories?

Stage I is limited to the ovaries; may involve 1 or 2 ovaries and can include positive peritoneal lavage (ascites).

What does Stage II signify in ovarian cancer?

Limited to the pelvis; involvement of uterus/fallopian tubes; extension to other pelvic tissues; positive peritoneal lavage.

What does Stage III signify in ovarian cancer?

Limited to the abdomen; intraabdominal extension outside pelvis/retroperitoneal nodes/extension to small bowel/omentum.

What does Stage IV signify in ovarian cancer?

Hematogenous disease (liver parenchyma) or spread beyond the abdomen.

Which two ovarian tumor types are commonly seen in pregnancy?

Dysgerminoma and serous cystadenoma.

What are epithelial tumors and what percentage of ovarian neoplasms do they account for?

Tumors arising from surface epithelium/stroma; account for 65–75% of all ovarian neoplasms and 80–90% of ovarian malignancies.

Which epithelial tumors are most common?

Serous and mucinous tumors (serous is the most common).

What is the difference between adenoma and adenocarcinoma in epithelial tumors?

Adenoma = benign form; adenocarcinoma = malignant form; cystic lesions may be labeled with the prefix cyst-; fibroma indicates fibrous tissue.

Are mucinous tumors more often bilateral or unilateral?

Less frequently bilateral than serous tumors.

Where do metastatic ovarian tumors primarily spread and what is a Krukenberg tumor?

Metastases usually spread intraperitoneally; Krukenberg tumors are bilateral ovarian metastases from GI tract (often stomach).

What is the typical sonographic pattern of ovarian metastases?

Frequently bilateral; often solid or solid with moth-eaten necrosis; ascites commonly present.

What percentage of ovarian neoplasms are metastatic?

Approximately 5–10%.

What are immature teratomas and what is a key marker?

Uncommon malignant germ cell tumors; rapidly growing solid; AFP elevated in about 50%; typically in girls aged 10–20.

What is a mature cystic teratoma (dermoid) and its ultrasound patterns?

Most common benign germ cell tumor; contains fat, sebaceous material, hair, cartilage, bone, teeth; may show a dermoid plug, fat–fluid level, or various patterns.

What is Meigs syndrome?

Ascites with a fibroma/thecoma, typically in postmenopausal women.

Which hormone do granulosa cell tumors often produce and what are clinical effects?

Estrogen; can cause precocious puberty, vaginal bleeding, breast changes, and may lead to torsion or Meigs syndrome.

What are Sertoli-Leydig cell tumors and what hormonal effect do they have?

Androblastoma/androblastoma; produce testosterone leading to virilization (hirsutism, deepened voice, clitoromegaly).

What is a distinguishing feature of endodermal sinus (yolk sac) tumors?

Rare malignant germ cell tumor; AFP may be elevated; usually unilateral with poor prognosis.

What proportion of ovarian tumors are epithelial?

Epithelial tumors account for 65–75% of all ovarian neoplasms and 80–90% of ovarian malignancies.

What is the typical pattern of ovarian lymphoma involvement?

Ovary involvement is usually diffuse, disseminated, bilateral, and presents as a solid hypoechoic mass.

What is the common primary source for Krukenberg tumors?

Gastric (stomach) cancer, though biliary tract and pancreas can also be sources.

What are two key ultrasound features of serous cystadenocarcinoma?

Cystic structure with septations and/or papillary projections; may have peritoneal implants and ascites.

What is the general management implication of a benign cystic teratoma on imaging?

Typically benign; often managed with observation or surgical removal if symptomatic or enlarging.