Applied Pathophysiology Chapter 14 Quiz

Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease - Chapter 14: Altered Reproductive Function

• The book is titled Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease
• The chapter discussed is Chapter 14: Altered Reproductive Function
• The module is Module 3: Clinical Models
• The book was published by Wolters Kluwer Health, Lippincott Williams & Wilkins in 2017.

Ovarian Cancer

• Pathophysiology:

  • Approximately 5-10% of ovarian cancers are inherited, linked to BRCA-1 and BRCA-2 tumor suppressor genes (3 inheritance patterns: ovarian-breast cancer, ovarian cancer alone, ovarian-colon cancer)
  • Most important risk factor: family history of a first-degree relative with the disease. The risk increases with more affected relatives.
  • Other risks include ovarian trauma from ovulation, injury and inflammatory response during ovulation, risk increases with repetitive ovulations. Hormonal factors (contraceptives, pregnancies, postmenopausal hormone therapy can also play a role).

• Types of Tumors:

  • Epithelial tumors: arise from the surface of the ovary.
    • Serous adenocarcinoma is the most common type
    • Resembles epithelial tissue of the fallopian tube.
  • Germ cell tumors: comprise 25% of ovarian tumors, mainly benign in adult women, but more often cancerous in children and young adults. Development is similar to testicular cancer.
  • Sex cord tumors: comprise 10% of ovarian tumors; arise from primitive sex cords or connective tissue of the developing ovary.

• Spread of Cancer:

  • Cancer spreads over the surface of the peritoneum.
  • Local shedding and implantation on the peritoneum commonly lead to invasion of the bowel and bladder.
  • Infiltration of pelvic lymph nodes is common.
  • Staging (I-IV) of ovarian cancer is performed at the time of diagnosis, based on extent of spread.

• Clinical Manifestations:

  • Often asymptomatic in early stages.
  • Vague abdominal bloating, pressure, pain and abdominal distention. Nausea. Vomiting. Changes in bowel habits.
  • Widespread disease is common at time of diagnosis.

• Diagnosis:

  • Patient history.
  • Physical examination (bimanual palpation of ovaries).
  • Transvaginal ultrasound, Laparoscopy or surgical exploration of the peritoneal cavity.
  • Cytologic examination of ovarian epithelial cells and surrounding peritoneal tissue, lymph nodes (with laparotomy).
  • Serum tumor marker levels (CA-125).
  • Monitoring treatment effectiveness.
  • Recurrence diagnosis.

• Treatment:

  • Based on the stage of the tumor
  • Early stages (I-II, well differentiated/moderately well differentiated): surgery (removal of uterus, both ovaries, surrounding omentum, diaphragm, multiple lymph nodes).
  • Less differentiated tumors/extensive spread: combination of surgery, adjuvant radiation, local and/or systemic chemotherapy.

• Prognosis:

  • Ovarian cancer is often curable if detected early.
  • Unfortunately, at the time of diagnosis, 3/4 women have spread to the pelvis or other distant sites. -Stage III or IV tumors that cannot be adequately removed via surgery: 5-year survival rate is less than 10%.
  • The composite 5-year survival rate for all patients diagnosed with ovarian cancer is 35%.
  • More favorable prognosis associated with younger age at diagnosis, cell type other than mucinous/clear cell, lower stage, greater cell differentiation, and smaller size of the tumor. Absent ascites (fluid accumulation). Adequate response to surgery, radiation, or chemotherapy.