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

2. Question 1 A 66 year old women underwent a staging laparotomy, TAH, BSO and omentectomy for ovarian cancer. What is the most likely diagnosis? Click Here For Answer Serous cystadenocarcinoma Endometrioid adenocarcinoma Mucinous cystadenocarcinoma Clear cell cystadenocarcinoma Transitional cell carcinoma

3. Question 1 A 66 year old women underwent a staging laparotomy, TAH, BSO and omentectomy for ovarian cancer. What is the most likely diagnosis? Click Here For Next Question Serous cystadenocarcinoma Endometrioid adenocarcinoma Mucinous cystadenocarcinoma Clear cell cystadenocarcinoma Transitional cell carcinoma

4. 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? Click Here For Answer Infertility Oestrogen replacement therapy Diet / obesity Family history Talcum powder (perineal application)

5. 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? Click Here For Next Question Infertility Oestrogen replacement therapy Diet / obesity Family history Talcum powder (perineal application)

6. 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 Click Here For Answer 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

7. 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 Click Here For Next Question 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

8. 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? Click Here For Answer No further investigation Fine needle aspirate of adnexal mass Trucut biopsy of adnexal mass CT scan of abdomen / pelvis Staging laparotomy

9. 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? Click Here For Next Question No further investigation Fine needle aspirate of adnexal mass Trucut biopsy of adnexal mass CT scan of abdomen / pelvis Staging laparotomy

10. 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: Click Here For Answer Stage IV Stage IIB Stage IIIA Stage IIIB Stage IIIC

11. 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: Click Here For Next Question Stage IV Stage IIB Stage IIIA Stage IIIB Stage IIIC

12. 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: Click Here For Answer 1.5cm in diameter 0.2cm in diameter 0.5cm in diameter 0.7cm in diameter 1.0cm in diameter

13. 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: Click Here For Next Question 1.5cm in diameter 0.2cm in diameter 0.5cm in diameter 0.7cm in diameter 1.0cm in diameter

14. 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? Click Here For Answer Cisplatin / pactitaxel Single agent carboplatin Carboplatin / paclitaxel Carboplatin / docetaxel Cisplatin / docetaxel

15. 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? Click Here For Next Question Cisplatin / pactitaxel Single agent carboplatin Carboplatin / paclitaxel Carboplatin / docetaxel Cisplatin / docetaxel

16. 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? Click Here For Answer Adjuvant chemotherapy with 8 cycles of carboplatin / paclitaxel 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

17. 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? Click Here For Next Question Adjuvant chemotherapy with 8 cycles of carboplatin / paclitaxel 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

18. 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? Click Here For Answer 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

19. 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? Click Here For Next Question 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

20. 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? Click Here For Answer Repeat Ca125 in 8 weeks Repeat Ca125 in 6 months Repeat CT scan Chemotherapy with carboplatin / paclitaxel Chemotherapy with single agent carboplatin

21. 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? Click Here For Next Question Repeat Ca125 in 8 weeks Repeat Ca125 in 6 months Repeat CT scan Chemotherapy with carboplatin / paclitaxel Chemotherapy with single agent carboplatin

22. 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? Click Here For Answer ICON4 ICON5 ICON4, SCOTROC4 ICON5, SCOTROC4 ICON4, ICON5, SCOTROC4

23. 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? Click Here For Next Question ICON4 ICON5 ICON4, SCOTROC4 ICON5, SCOTROC4 ICON4, ICON5, SCOTROC4

24. 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? Click Here For Answer 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

25. 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? Click Here For Next Question 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

26. 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? Click Here For Answer 70 210 630 4130 None of the above

27. 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? Click Here For Next Question 70 210 630 4130 None of the above

28. 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? Click Here For Answer Chemo-sensitive Chemo-refractory Chemo-resistant Partially chemo-resistant Partially chemo-sensitive

29. 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? Click Here For Next Question Chemo-sensitive Chemo-refractory Chemo-resistant Partially chemo-resistant Partially chemo-sensitive

30. 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? Click Here For Answer Stage of disease Ca125 Age Extent of debulking surgery Response to platinum

31. 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? Click Here For Next Question Stage of disease Ca125 Age Extent of debulking surgery Response to platinum

32. 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? Click Here For Answer 10% 50% 40% 30% 20%

33. 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? Click Here For Next Slide 10% 50% 40% 30% 20%

34. The End