Oncology Registrars’ Forum

“Best of Five”

Ovarian Cancer
May 2007
Dr Anna Winship
Guy’s & St. Thomas’ NHS Trust

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First Question
 Question 1
• A 66 year old women underwent a staging laparotomy, TAH, BSO
and omentectomy for ovarian cancer. What is the most likely
diagnosis?

Serous cystadenocarcinoma

Endometrioid adenocarcinoma

Mucinous cystadenocarcinoma

Clear cell cystadenocarcinoma

Transitional cell carcinoma

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Answer
 Question 1
• A 66 year old women underwent a staging laparotomy, TAH, BSO
and omentectomy for ovarian cancer. What is the most likely
diagnosis?

Serous cystadenocarcinoma

Endometrioid adenocarcinoma

Mucinous cystadenocarcinoma

Clear cell cystadenocarcinoma

Transitional cell carcinoma

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Next Question
 Question 2
• A 66 year old women underwent a staging laparotomy, TAH, BSO
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)

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Answer
 Question 2
• A 66 year old women underwent a staging laparotomy, TAH, BSO
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)

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Next Question
 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 M x age

U x M x Ca125

M x age x Ca125

U x age x Ca125

U x age x M x Ca125

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Answer
 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 M x age

U x M x Ca125

M x age x Ca125

U x age x Ca125

U x age x M x Ca125

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Next Question
 Question 4
• A 35 year old women complained of right sided pelvic pain and was
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

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Answer
 Question 4
• A 35 year old women complained of right sided pelvic pain and was
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

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Next Question
 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 IIB

Stage IIIA

Stage IIIB

Stage IIIC

Stage IV

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Answer
 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 IIB

Stage IIIA

Stage IIIB

Stage IIIC

Stage IV

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Next Question
 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:

0.2cm in diameter

0.5cm in diameter

0.7cm in diameter

1.0cm in diameter

1.5cm in diameter

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Answer
 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:

0.2cm in diameter

0.5cm in diameter

0.7cm in diameter

1.0cm in diameter

1.5cm in diameter

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Next Question
 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?

Single agent carboplatin

Carboplatin / paclitaxel

Carboplatin / docetaxel

Cisplatin / docetaxel

Cisplatin / pactitaxel

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Answer
 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?

Single agent carboplatin

Carboplatin / paclitaxel

Carboplatin / docetaxel

Cisplatin / docetaxel

Cisplatin / pactitaxel

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Next Question
 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?

Observation with serial Ca125

Adjuvant chemotherapy with 6 cycles of carboplatin

Adjuvant chemotherapy with 8 cycles of carboplatin

Adjuvant chemotherapy with 6 cycles of carboplatin / paclitaxel

Adjuvant chemotherapy with 8 cycles of carboplatin / paclitaxel

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Answer
 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?

Observation with serial Ca125

Adjuvant chemotherapy with 6 cycles of carboplatin

Adjuvant chemotherapy with 8 cycles of carboplatin

Adjuvant chemotherapy with 6 cycles of carboplatin / paclitaxel

Adjuvant chemotherapy with 8 cycles of carboplatin / paclitaxel

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Next Question
 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?

Observation with serial Ca125

Adjuvant chemotherapy with 6 cycles of carboplatin

Adjuvant chemotherapy with 8 cycles of carboplatin

Adjuvant chemotherapy with 6 cycles of carboplatin / paclitaxel

Adjuvant chemotherapy with 8 cycles of carboplatin / paclitaxel

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Answer
 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?

Observation with serial Ca125

Adjuvant chemotherapy with 6 cycles of carboplatin

Adjuvant chemotherapy with 8 cycles of carboplatin

Adjuvant chemotherapy with 6 cycles of carboplatin / paclitaxel

Adjuvant chemotherapy with 8 cycles of carboplatin / paclitaxel

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Next Question
 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 single agent carboplatin

Chemotherapy with carboplatin / paclitaxel

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Answer
 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 single agent carboplatin

Chemotherapy with carboplatin / paclitaxel

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Next Question
 Question 11
• A 40 year old woman underwent a staging laparotomy, TAH, BSO
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

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Answer
 Question 11
• A 40 year old woman underwent a staging laparotomy, TAH, BSO
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

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Next Question
 Question 12
• A 57 year old woman underwent a staging laparotomy, TAH, BSO
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

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Answer
 Question 12
• A 57 year old woman underwent a staging laparotomy, TAH, BSO
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

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Next Question
 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

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Answer
 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

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Next Question
 Question 14
• 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. How would you define her disease?

Chemo-refractory

Chemo-resistant

Partially chemo-resistant

Partially chemo-sensitive

Chemo-sensitive

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Answer
 Question 14
• 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. How would you define her disease?

Chemo-refractory

Chemo-resistant

Partially chemo-resistant

Partially chemo-sensitive

Chemo-sensitive

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Next Question
 Question 15
• 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 important prognostic factor?

Ca125

Age

Extent of debulking surgery

Response to platinum

Stage of disease

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Answer
 Question 15
• 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 important prognostic factor?

Ca125

Age

Extent of debulking surgery

Response to platinum

Stage of disease

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Next Question
 Question 16
• 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 her overall 5-year survival rate?

50%

40%

30%

20%

10%

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Answer
 Question 16
• 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 her overall 5-year survival rate?

50%

40%

30%

20%

10%

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Next Slide
The End