Other (toxic shock syndrome, neoplasms, torsion) Flashcards
Prognosis, screening, most common type of ovarian cancer?
- Worse prognosis, high mortality due to syx presenting vague until relatively advanced. 5yr survival rate of 46%.
- There are no screening programmes
- Most common type is EPITHELIAL ovarian tumours (90%)
RF + protective factors of ovarian cancer
RF:
- Older age (peak at 60y)
- smoking
- obesity
- HRT
- BRAC1 +2, FH.
- Factors that increase no of ovulations, increase risk: early menarche, late menopause, nulliparous, regular use of clomifene.
Protective factors (factors that stop ovulation or reduce no. of lifetime ovulations, reduce the risk):
- Parity
- Breastfeeding
- Early menopause
- COCP
2ww referral criteria for ovarian Ca + when should u consider testing for it
(1.) Any women with ascites +/- unexplained pelvic/abdo mass
(2. ) Consider TESTING if
(a) >50y with:
- abdo distention
- early satiety
- pelvic/abdo pain
- urinary freq/urgency
(B) unexplained wt loss, fatigue or changes in bowel
(c) >50y with syx of IBS
Ix for ovarian Ca
Initial ix whilst waiting for referral
- Ca125 (>35 significant), note this not a specific marker
- TV + TA USS
- Calculate ‘Risk Malignancy Index’ with above Ix
Secondary care
- Laparotomy + biopsy (dx)
- CT for FIGO staging
- AFP + bHCG , <40y require tumour markers for a possible germ cell tumour
What is the Risk malignancy Index
Stratify the likelihood of ovarian cancer. This is calculated by USS score x menopausal score x Ca125 level
- USS score = 0-3 for no. of abnormalities (multilocular cysts, ascites, mets, bilateral cysts, solid area)
- Menopausal score = 1 for pre-menopausal, 3 for post-menopausal.
Management of ovarian ca
Depends on stage and pt’s fitness for treatment, involves gynae oncology MDT, palliative team.
- Surgery: total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO)
- Chemotherapy
What is an ovarian torsion? Causes? RF?
- It is a surgical emergency.
- Ovary twists in relation to the surrounding connective tissue, fallopian tube and blood supply, this can lead to ischaemia. If persist can lead to necrosis and function of ovary is lost.
- Necrotic ovary can become infected, develop abscess and lead to sepsis. It may also rupture causing peritonitis.
- Causes: ovarian mass >5cm (tumour or cyst).
- RF: pregnancy, younger girls before menarche
Presentation of ovarian torsion?
(1. ) Sudden unilateral pelvic pain
- Constant and gets progressively worse
- Is can be milder and intermittent too if ovary twist and untwist.
(2.) N+V
O/e
- localised tenderness
- palpable pelvic mass (although absence does not exclude dx)
Dx of ovarian torsion
(1. ) Pelvic USS
- ‘Whirlpool sign’ due to free fluid in pelvis + oedema of ovary
(2) . Doppler studies may show lack of blood flow
(3. ) Laparoscopic surgery - definite dx
Management of ovarian torsion
(1. ) Laparoscopic surgery to perform either:
- Detorsion: untwist ovary + fix it in place
- Oophorectomy: remove affected ovary
(2.) Laparotomy - if larger mass or malignancy is suspected
WHat is Toxic Shock Syndrome? Cause? RF?
- Severe systemic reaction caused by staph aureus or group A strept bacteria getting into the body and releasing harmful toxins
- It is a medical emergency
RF:
- tampons, contraceptive diaphragms, cuts/burns/boils, childbirth, nasal packing, stap or strep infection
Clinical features of Toxic Shock Syndrome
- fever
- chills
- hypotension
- erythematous rash
- multisystem organ involvement: GI: N+V, diarrohea, Renal failure, CNS: confusion
- nonspecific syx: myalgias, headache, or syx of pharyngitis (e.g., a sore throat, painful swallowing),
Management of Toxic Shock Syndrome
(1. ) ABCDE
(2. ) Removal of infection e.g. tampon
(3. ) IV fluids & Abx
(4. ) Oxygen
(5. ) Surgery - if debridement needed
