Functional Ovarian cysts & Ovarian CA

Question 1

A patient is asking you what a follicular cyst is–how do you explain?

Answer 1

Occurs when follicles fail to rupture & continue to grow

Question 2

What is a corpus luteal cyst?

Answer 2

Occurs when the corpus luteus fails to degenerate after ovulation

Question 3

What causes a Theca Lutein cyst?

Answer 3

excess B-hCG causes hyperplasia of theca interna cells

Question 4

A patient says she has a history of functional ovarian cysts, how would you expect this patient to present?

Answer 4

1. Most are asymptomatic until they rupture, undergo torsion. or become hemorrhagic –> RLQ or LLQ pain.
2. Menstrual changes (abnormal uterine bleeding)
3. Dysparenuria

Question 5

A patient says she has a history of functional ovarian cysts. As part of her PE, you perform a pelvic U/S. There is a complex, thicker-walled cyst with peripheral vascularity. What type of cyst is this? And what is the next best step in managing this patient?

Answer 5

Luteal; order B-hCG to rule out pregnancy

Question 6

A patient says she has a history of functional ovarian cysts. As part of her PE, you perform a pelvic U/S. There are smooth, thin-walled unilocular cyst. What type of cyst is this? And what is the next best step in managing this patient?

Answer 6

Follicular; order B-hCG to rule out pregnancy

Question 7

A patient says she has a history of functional ovarian cysts. As part of her PE, you perform a pelvic U/S. There are smooth, thin-walled unilocular cyst. You determine she has a follicular ovarian cyst measuring <8cm. How do you manage this patient?

Answer 7

Supportive: most cysts are functional & usually spontaneously resolve –> rest, NSAIDS, repeat U/S after 6 wks

Question 8

A patient says she has a history of functional ovarian cysts. As part of her PE, you perform a pelvic U/S. There are smooth, thin-walled unilocular cyst. You determine she has a follicular ovarian cyst measuring >8cm. How do you manage this patient?

Answer 8

+/- laparoscopy or laparotomy

Question 9

What is the 2nd MC gynecological cancer?

Answer 9

Ovarian cancer

-Endometrial is 1st

Question 10

Which cancer has the highest mortality of all gynecological cancers?

Answer 10

Ovarian

Question 11

What are the risk factors to Ovarian cancer?

Answer 11

1. • family hx –> 7% lifetime risk (normal risk = 1-2%)
2. increased # of ovulatory cycles (infertility, nulliparity, >50y, late menopause)
3. BRCA-1, BRCA-2 (15-40%)
4. P eutz-Jehgers
5. Turner’s syndrome

Question 12

What are protective factors to Ovarian cancer?

Answer 12

1. OCPs* (decreases # of ovulatory cycles)
2. High parity
3. TAH

Question 13

What clinical manifestations would be indicative of Ovarian cancer?

Answer 13

1. Rarely symptomatic until late in disease course (extensive METS)
2. Presents usually 40-60y
3. Abdominal fullness/distention
4. Back or abdominal pain
5. Early satiety
6. Urinary frequency
7. Irregular menses: menorrhagia, postmenopausal bleeding, constipation (internal compression)

Question 14

What PE findings would be consistent in a patient diagnosed with Ovarian CA?

Answer 14

1. Palpable abdominal or ovarian mass (solid, fixed, irregular)
2. +/- ascites*
3. Sister Mary Joseph’s node: METS to the umbilical lymph nodes

Question 15

How is a patient suspected of Ovarian CA diagnosed?

Answer 15

Biopsy: 90% epithelial* (seen esp postmenopausal)

-Germ cell seen in patients <30y

Question 16

Which ovarian biopsy would be more consistent with a patient diagnosed with Ovarian CA <30y?

Answer 16

Germ cell seen in patients <30y

Question 17

Which type of diagnostic imaging is useful for screening high risk patients for Ovarian CA?

Answer 17

Transvaginal U/S

*Mammography to look for primary in breast

Question 18

How do you manage early stage Ovarian CA?

Answer 18

TAH-BSO + selective lymphadenectomy

Question 19

How are Ovarian CA patients monitored during treatment progress?

Answer 19

Serum CA-124

Question 20

What is the MC benign ovarian neoplasm?

Answer 20

Dermoid cystic teratomas

Question 21

How is the MC benign ovarian neoplasm managed?

Answer 21

Dermoid cystic teratomas

Manage= Removal (due to potential risk of torsion or malignant transformation)

Question 22

What are risk factors to a Dermoid cystic teratoma?

Answer 22

1. Risk of malignancy increases with age
2. Occurs during the reproductive age
3. 90% of ovarian neoplasms are benign