Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

CHAPTER 35
Epithelial Ovarian Cancer

35–1. What percentage of epithelial ovarian cancers are hereditary?

a. 1

b. 10

c. 15

d. 20

35–2. Which of the following is not a risk factor for ovarian cancer?

a. Nulliparity

b. Late menopause

c. Combination oral contraceptive pill use

d. Hereditary nonpolyposis colon cancer (HNPCC)

35–3. Which of the following genetic mutations is associated with the highest risk of developing ovarian cancer?

a. Phosphatase and tensin homolog (PTEN)

b. Hereditary Breast Ovarian Cancer Syndrome 1 (BRCA1)

c. Hereditary Breast Ovarian Cancer Syndrome 2 (BRCA2)

d. MutL homolog 1, colon cancer, nonpolyposis type 2 (MLH1)

35–4. A 40-year-old woman with a BRCA1 mutation undergoes a laparoscopic bilateral salpingo-oophorectomy (BSO) for risk reduction. By what percentage is her breast cancer risk reduced by her BSO?

a. 25

b. 50

c. 75

d. 90

35–5. What is the main histologic difference between a low malignant potential tumor and epithelial ovarian cancer?

a. Stromal invasion

b. Mitotic activity

c. Degree of nuclear atypia

d. Nuclear-to-cytoplasmic ratio

35–6. A 55-year-old healthy woman undergoes exploration for a large pelvic mass (shown below). Frozen section analysis of her right ovary notes “mucinous low malignant potential, cannot exclude invasion.” There is no other obvious disease. What surgical procedures should be performed, in addition to total abdominal hysterectomy and bilateral salpingo-oophorectomy?

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a. Pelvic washings, omentectomy, multiple peritoneal biopsies

b. Pelvic washings, omentectomy, multiple peritoneal biopsies, bilateral pelvic and para-aortic lymph node dissection

c. Pelvic washings, omentectomy, multiple peritoneal biopsies, bilateral pelvic and para-aortic lymph node dissection, appendectomy

d. None of the above

35–7. A 27-year-old nulligravida who desires future fertility underwent a laparoscopic left salpingo-oophorectomy for a 7-cm cyst. The cyst was removed intact, and washings were negative. Final pathology revealed a serous low malignant potential tumor. What is the most appropriate management?

a. Close observation

b. Right salpingo-oophorectomy (RSO), omentectomy, multiple peritoneal biopsies

c. RSO, omentectomy, multiple peritoneal biopsies, bilateral pelvic and para-aortic lymph node dissection

d. Hysterectomy, RSO, omentectomy, multiple peritoneal biopsies, bilateral pelvic and para-aortic lymph node dissection

35–8. Which of the following is the worst prognostic feature associated with low malignant potential (LMP) tumors?

a. Advanced stage

b. Invasive implants

c. Mucinous histology

d. Stromal microinvasion

35–9. Which of the following is FALSE regarding ovarian cancer symptoms?

a. Most women with ovarian cancer experience symptoms 20 to 30 days per month.

b. Women with ovarian cancer do not have symptoms until the disease is very advanced.

c. The most frequent symptoms associated with ovarian cancer include urinary urgency, pelvic pain, and bloating.

d. None of the above

35–10. What percentage of patients with stage I ovarian cancer have a normal cancer antigen 125 (CA125) level?

a. 5

b. 15

c. 25

d. 50

35–11. Which of the following conditions can create an elevated CA125 level?

a. Leiomyomas

b. Endometriosis

c. Congestive heart failure

d. All of the above

35–12. Which of the following radiologic tests is most helpful in a patient with suspected advanced ovarian cancer?

a. Transvaginal ultrasound

b. Positron emission tomography (PET) scan

c. Magnetic resonance (MR) imaging of the pelvis

d. Computed tomography (CT) scan of the abdomen and pelvis

35–13. Which one of the following women does not need referral to a gynecologic oncologist?

a. A 35-year-old with a complex 7-cm adnexal mass and a CA125 level of 75

b. A 60-year-old with a complex 7-cm adnexal mass and a CA125 level of 75

c. A 35-year-old with a complex 7-cm adnexal mass, ascites, and a CA125 level of 75

d. A 50-year-old with a complex 7-cm fixed adnexal mass and a CA125 level of 25

35–14. In the photomicrograph below, to what structures are the white arrows pointing? (Hint—this finding is pathognomonic for the most common histologic cell type of epithelial ovarian cancer.)

Image

Photograph contributed by Dr. Kelley Carrick.

a. Signet rings

b. Hobnail cells

c. Keratin pearls

d. Psammoma bodies

35–15. Shown here, what is the most common cell type of epithelial ovarian cancer associated with endometriosis?

Image

Reproduced, with permission, from Schorge JO: Epithelial ovarian cancer. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 35-14.

a. Mucinous

b. Clear cell

c. Endometrioid

d. Papillary serous

35–16. A 27-year-old presents to the emergency department with a complaint of increasing abdominal distension, constipation, and weight loss. A computed tomo-graphic (CT) scan reveals a 10-cm right adnexal mass and retroperitoneal lymphadenopathy. Her serum CA125 level is 45, β-human chorionic gonadotropin (β-hCG) concentration is less than 5, and alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH) levels are normal. Her serum calcium level is 15. What is the most likely diagnosis?

a. Lymphoma

b. Small cell ovarian cancer

c. Primary hyperparathyroidism

d. Malignant germ cell tumor of the ovary with bone metastasis

35–17. Which of the following is NOT a characteristic of Krukenberg tumors?

a. They are bilateral.

b. They usually arise from primary gastric tumors.

c. They are usually the only site of metastatic disease.

d. They are comprised of mucinous and signet ring cells.

35–18. What is the most common method of ovarian cancer spread?

a. Lymphatic

b. Hematogenous

c. Direct extension

d. Tumor exfoliation

35–19. Which of the following correctly indicates the cephalad border of the para-aortic lymph node dissection for ovarian cancer clinically confined to the ovary?

Image

Photograph contributed by Dr. Jayanthi Lea.

a. A

b. B

c. C

d. D

35–20. A 40-year-old woman with a right-sided pleural effusion undergoes exploratory laparotomy for a pelvic mass and elevated CA125 level. Cytologic analysis of the pleural fluid reveals no malignant cells. Upon exploration, the finding below is seen. Which International Federation of Gynecology and Obstetrics (FIGO) stage is she?

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Photograph contributed by Dr. John Schorge.

a. IIA

b. IIC

c. IIIA

d. IIIC

35–21. What percentage of women with ovarian cancer clinically confined to the ovaries will be upstaged by surgery?

a. 10

b. 25

c. 33

d. 50

35–22. Which of the following patients does not need adjuvant chemotherapy following surgery for epithelial ovarian cancer?

a. A 65-year-old following total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, multiple peritoneal biopsies, and pelvic and para-aortic lymph node dissection for a stage IC clear cell ovarian cancer

b. A 45-year-old following total abdominal hysterectomy, bilateral salpingo-oophorectomy, omen-tectomy, multiple peritoneal biopsies, and pelvic lymph node dissection for a stage IA grade 1 endometrioid adenocarcinoma of the ovary

c. A 55-year-old following total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, multiple peritoneal biopsies, and pelvic and para-aortic lymph node dissection for a stage IB grade 1 papillary serous carcinoma of the ovary

d. A 70-year-old following total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, multiple peritoneal biopsies, and pelvic and para-aortic lymph node dissection for a stage IC grade 1 papillary serous carcinoma of the ovary

35–23. What is the goal of cytoreductive surgery for advanced ovarian cancer?

a. Remove all tumors larger than 1 cm

b. Remove all tumors larger than 2 cm

c. Remove all tumors larger than 0.5 cm

d. Remove all gross disease

35–24. Which of the following chemotherapy regimens is associated with the longest overall survival for women with optimally debulked (less than 1 cm residual disease) stage III epithelial ovarian cancer?

a. Single agent carboplatin

b. Intravenous (IV) carboplatin and paclitaxel

c. Intraperitoneal (IP) cisplatin and paclitaxel

d. Intravenous (IV) carboplatin, paclitaxel, and bevacizumab

35–25. A woman with a history of stage IIIC ovarian cancer who underwent optimal cytoreductive surgery followed by six cycles of intraperitoneal (IP) cisplatin and paclitaxel recurs 4 months after completion of chemotherapy. She complains of bloating and decreased appetite. Which of the following is the most appropriate treatment?

a. Tamoxifen

b. Intravenous (IV) carboplatin

c. IV carboplatin and paclitaxel

d. Pegylated liposomal doxorubicin

35–26. Which of the following chemotherapy regimens is appropriate treatment of a patient with recurrent platinum-sensitive ovarian cancer?

a. Carboplatin with paclitaxel

b. Carboplatin with gemcitabine

c. Carboplatin with pegylated liposomal doxorubicin

d. All of the above

Chapter 35 ANSWER KEY

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