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Gynaecology > 1: Gynaecological cancers - Ovarian Cysts and Cancer > Flashcards

1: Gynaecological cancers - Ovarian Cysts and Cancer Flashcards

1
Q

What is an ovarian cysts

A

Fluid-filled sac of the ovary

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2
Q

What is a simple ovarian cyst

A

Solely contains fluid

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3
Q

What is a complex ovarian cyst

A

Contains solid components

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4
Q

How are ovarian cysts usually divided

A

Neoplastic

Non-neoplastic

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5
Q

What are neoplastic ovarian cysts

A

Ovarian cysts that have potential to become malignant

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6
Q

What are non-neoplastic ovarian cysts

A

Ovarian cysts with no malignant potential

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7
Q

Name two functional non-neoplastic ovarian cysts

A

Follicular cyst

Corpus luteal cyst

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8
Q

What size are follicular cysts

A

<3cm

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9
Q

What are follicular cysts and when are they present

A

Cysts due to developing follicles in the ovaries. Present during first-half of the menstrual cycle

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10
Q

What size are corpus luteal cysts

A

<5cm

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11
Q

When are corpus luteal cysts present

A

During second-half (luteal phase) of the menstrual cycle

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12
Q

What are 3 pathological non-neoplastic ovarian cysts

A

Endometrioma
Theca lutein cyst
PCOS

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13
Q

What is an endometrioma

A

‘Chocolate’ cyst seen in ovaries in endometriosis

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14
Q

What is the criteria for PCOS

A

> 12 cysts in each follicle

Or, ovarian volume >10ml

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15
Q

How do cysts appear in PCOS on US

A

Ring of pearls - as all the cysts are in the outer aspect

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16
Q

What causes theca lutein cysts

A

High levels of bHCG

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17
Q

When may theca lutein cysts of the ovary be present

A

Molar pregnancies

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18
Q

What are 3 benign neoplastic epithelial cysts

A
  1. Mucinous Cystoadenoma
  2. Serous Cystoadenoma
  3. Brenner tumour
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19
Q

What can serous cystoadenoma become

A

Become most common malignant ovarian tumour (serous)

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20
Q

Are serous cystoadenomas usually unilateral or bilateral

A

Unilateral

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21
Q

what is a feature of mutcnous cystoadenoma

A

Unilateral

Several in one ovary

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22
Q

how does a brenner tumour present

A

Solid white-yellow mass

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23
Q

what is a benign neoplastic germ cell tumour of the ovary

A

dermoid cyst

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24
Q

what is a dermoid cysts also known as

A

mature cystic teratomas

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25
Q

is mature cystic teratoma unilateral or bilateral

A

unilateral

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26
Q

when do mature cystic teratomas often occur

A

during pregnancy

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27
Q

describe features of mature cystic teratomas

A

due to ‘embryologically’ being derived from other tissue - can contain teeth, hair and skin cells

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28
Q

what is a benign neoplastic sex-chord stromal tumour

A

fibroma

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29
Q

what is the most common stromal tumour

A

fibroma

30
Q

what do 40% of individuals with fibromas present with

A

Meig’s syndrome

31
Q

what is meig’s syndrome

A

Fibroma and pleural effusion or ascites

32
Q

in which individuals are ovarian cysts more common

A

Pre-menopausal individuals

33
Q

how do most ovarian cysts present

A

asymptomatically

34
Q

why may ovarian cysts present with chronic pelvic pain

A

pressure on bladder or bowel

35
Q

in a pre-menopausal women, what blood tests should be performed and why

A

LDH
AFP
bHCG
= due to higher risk of germ-cell tumours in under 40’s

36
Q

explain next-step in work-up of pre-menopausal women with an ovarian cysts

A

Re-scan cyst as 6W

37
Q

if the scan is still present at 6W, what monitoring should be offered

A

Ca125: every 3-6 months

Calculate risk malignancy index (RMI)

38
Q

if the cyst is >5cm at the 6W follow up scan what should be considered

A

Cystectomy or oophorectomy

39
Q

if post-menopausal women have an ovarian cyst what should first be calculated

A

Risk malignancy index

40
Q

what defines a low RMI

A

<25

41
Q

if a post-menopausal women has an RMI <25 what is offered

A

US at 1-year

Ca125

42
Q

what defines moderate RMI

A

25-250

43
Q

if an individual has a moderate RMI what is offered

A

bilateral oophorectomy

44
Q

what defines a high RMI

A

> 250

45
Q

how is high RMI managed

A

staging laparotomy

46
Q

in which age-group are ovarian cancers more common

A

> 65

47
Q

what is thought to cause ovarian cancer

A

irritation of epithelium during ovulation

48
Q

what are 5 RF for ovarian cancer

A
  1. Early menarche
  2. Late menopause
  3. Nulliparous
  4. Obesity
  5. Smoking
  6. FH
49
Q

What two genetic syndromes are associated with ovarian cancer

A

Lynch

BRCA

50
Q

What cancers does BRCA 1 and 2 increase risk of

A

Breast and Ovarian cancer

51
Q

What is offered in BRCA1 and 2 carriers

A

Prophylactic bilateral salpingoopherectomy

52
Q

What is BRCA 2 mutation associated with in men

A

Prostate cancer

53
Q

What chromosome is BRCA 1

A

Chromosome 13

54
Q

What chromosome is BRCA 2

A

Chromosome 17

55
Q

What are 3 protective factors for ovarian cancer

A
  1. Multiparous
  2. Breast Feeding
  3. COCP
56
Q

How do majority of ovarian cancers present

A

Asymptomatically
Chronic pain
PV bleed

57
Q

When is the problem with ovarian cancer

A

Often presents with non-specific symptoms leading to late diagnosis

58
Q

When should ovarian cancer be suspected

A

Post-menopausal women with:

  • PV Bleed
  • Change in bowel habit
  • Change in urinary habit
  • Bloating
  • Weight loss
  • New-onset IBS symptoms
59
Q

What are ovarian cancers usually

A

Epithelial sub-types

60
Q

What are the two types of ovarian cancers

A

Serous cystoadenomas

Mucinous cystoadenomas

61
Q

What are serous cystoadenomas characterised by

A

psammoma bodies

62
Q

What are mucinous cystoadenomas characterised by

A

mucin vacuoles

63
Q

what blood tests should all women with suspected ovarian cancer receive

A 
FBC 
LFT 
U+E 
Albumin 
CA125
64
Q

what imaging is used for ovarian cancer

A

AUS and pelvic-US

65
Q

what tool is used to determine risk of ovarian cancer

A

Risk Malignancy Index (RMI)

66
Q

how is the risk malignancy index calculated

A

Menopausal status x US score x CA125

67
Q

when are individuals referred to gynaecology under 2W rule

A

RMI >250

68
Q

if ovarian cancer is confirmed what investigations are performed for staging

A

CT CAP

CXR

69
Q

if individuals have a high-risk RMI what will be performed

A

De-bulking laparotomy

70
Q

what should all patients with ovarian cancer receive

A

Chemotherapy

71
Q

explain follow-up for ovarian cancer

A

CA-125 and Clinical exam follow-up for the next 5-years

Gynaecology (22 decks)

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