Lec7 Ovarian Cysts Flashcards
How are the ovaries linked to the uterus?
By the ovarian ligament
What is separates the uterus and rectum?
The peritoneal pouch - the Pouch of Douglas
From when are the primordial follicles present in a female?
Primordial follicles are present in the baby in utero
Name two types of cyst and when they occur
Functional cyst - forms in the Graafian follicle stage
Luteal cyst - form in the corpus luteum stage
When women ovulate, they often feel a pain in one side, what is this pain from?
When the corpus luteum has breached the capsule and causes injury.
What can happen in a luteal cyst?
May have some bleeding - haemorrhage - from it
What are the complications of ovarian cysts?
- Torsion
- Rupture
- Haemorrhage
- Infection
What must you try to do in an ovarian cyst rupture?
Try to manage conservatively if this is appropriate i.e. only if it is not a medical emergency
What is important to consider in a ruptured cyst?
The contents of the rupture and how much of it there is
Why is it important to consider the contents of the rupture?
Can cause peritonitis
or
pseudomyxoma peritonei
What does adnexum mean?
Next to the womb
What must you always remember to do?
Do a pregnancy test
CANNOT MISS an ECTOPIC PREGNANCY
What might be causing tenderness in an ovarian cyst haemorrhage?
The bleeding likely to cause the pain
What can be the result of untreated ectopic pregnancy?
Death
Why are ovaries prone to cyst formation?
Because of their dynamic nature
Why does torsion occur?
The ovarian arteries (come from high up near the renal arteries) and ovarian ligament make a sort of hammock which the ovaries hang off. The ovarian arteries wrap around the ovary so in torsion the ovary can get twisted and pulled upwards
Name the different cell types in the ovary
Germinal epithelium
Germ cells
Stroma
What happens in the germinal epithelium?
Most cysts occur from the germinal epithelium
What does the germ cell layer produce?
Makes eggs
What does the stroma produce?
Hormones
What other tissue types can form tumours?
Fibrous tissue and fat
What is the usual treatment of ovarian torsion?
Salpingo-oophorectomy
How can most cysts be treated?
With conservative management
Are most cysts symptomatic or asymptomatic?
Asymptomatic - a woman may have cysts that come and go away and not even be aware of it
What is the first type of imaging you would do with any presentation of pain in these kind of scenarios?
Ultrasound
What are the second most common cysts after functional cysts?
Benign dermoid cysts
What cell type do benign dermoid cysts come from?
The germ cell layer
What do you test for if you are worried the dermoid cyst might be malignant?
Tumour markers e.g.
Beta HCG - raised in germ cell tumours
Alpha lactate dehydrogenase - raised in dysgerminomas
What can often be found inside germ cell cysts?
Teeth, hair, nails, thyroid tissue, bone because the germ cells make the eggs - make the babies so have the potential to make any cell type in the body
What can rupture of a dermoid cyst cause?
Peritonitis
A pt presents with recent onset of amenorrhoea, hair recession, hirsutism, clitoromegaly and tender mass on left side of pelvis. What is the diagnosis likely to be?
A androgen producing tumour
Sertoli-leydig cell tumour most common in this scenario
Which cell layer do androgen producing tumours come from?
The stroma
What is the treatments and prognosis for a stage 1 androgen producing tumour?
Treatment is laparotomy of the tumour and prognosis is good because rarely bilateral
What are the types of epithelial ovarian tumour possible?
Benign
Borderline
Malignant
How do you calculate the Risk of malignancy index?
RMI = Menopausal status x Ultrasound score x CA125
Above what score is deemed cancer?
A score of 250 and above
Why is USS complexity important?
Important but not the be all and end all
If there is high complexity - more septae or more divisions it is more worrying likely to be malignant
Out of the cancers limited to the ovary - how many out of ten produce CA125?
7/10
What is the prognosis of women diagnosed with Epithelial Ovarian Cancer?
It is rare
Of those women diagnosed with it - most women won’t survive 5 years
Why is there no screening test rolled out nationally?
Because can use USS and CA125 but they are not accurate enough to create a nationwide screen - not cost effective - could miss lots of cases or could give lots of false positives
Why is epithelial ovarian cancer a silent disease?
60-80% women present at an advanced stage
Due to abdominal symptoms or symptoms from distant metastasis
General malaise, weight loss
A stage one epithelial ovarian tumour once lifted out you might have cured her: true or false?
True - if it is smooth - even if it is heavy - can get really heavy ones weighing 30kg+ but likely to be cured
What presentation is harder to get rid of?
Cauliflower presentation of the tumour - harder to get all the bits out - more likely to metastasise
Why is there an opportunity for several different types of tumours in the ovary?
Because of the diversity of the tissue types
What is the effect on malignancy with increasing age?
Increasing age = increasing malignancy
What determines management of a tumour?
The type of tumour and stage of disease at presentation
When is it more likely that a cure is possible
At early stages of the disease
What increases chances of malignancy?
Increasing age
High complexity of the tumour
How common are ovarian cysts presenting in gynae?
4th most common cause of gynae admission
