Ovarian cancer

Question 1

What is the arterial, venous supply of the ovaries?

Answer 1

Arterial: ovarian arteries leave from L1, below renal arteries on the aorta. They travel via suspensory ligament. They anastamose with uterine artery.

Venous: left ovarian artery drains into left renal vein, and right ovarian artery drains into the IVC directly.

Suspensory ligament travels to the meso-ovarium and into the hilum of the ovaries.

Question 2

What is the lymphatic drainage of the ovaries, uterus and vagina?

Answer 2

• Ovaries: they drain into para-aortic LN
• Upper uterus: external iliac LN –> para-aortic LN
• Lower uterus, cervix and upper vagina: sacral, internal and external iliac LN –> para-aortic LN
• Lower vagina: superficial inguinal LN –> external iliac LN –> para-aortic LN

Para-aortic LN –> cisterna chyli –> thoracic duct

Question 3

What type of nervous supply does female reproductive tract receive?

1. Sympathetic
2. Parasympathetic
3. Autonomic
4. Somatic

Answer 3

Answer: all four

Question 4

How does the female reproductive tract receive sympathetic nervous supply?

Answer 4

Ovaries: aortic plexus

Uterus and cervix: inferior hypogastric plexus

Question 5

How does the female reproductive tract receive parasympathetic nervous supply?

Answer 5

Ovaries: inferior hypogastric plexus

Uterus and cervix: inferior hypogastric plexus

Question 6

How does the female reproductive tract receive somatic nervous supply?

Answer 6

Vagina: pudendal and ilioinguinal nerve
Clitoris: dorsal nerve of clitoris (branch of pudendal nerve)

Question 7

What are the muscles of the pelvic floor?

Answer 7

Puborectalis (assists with defecation through maintaining its tone)
Pubococcygeus (assists with urinary system and micturition by holding the neck of the bladder)
Iliococcygeus (forms levator ani with pubococcygeus muscle)

Question 8

What is the treatment for ovarian cancer?

Answer 8

• Surgical staging is required for early stages of the disease (omentectomy, LN dissection, staging histopathology)
• Those at risk of recurrence, adjuvant chemotherapy is strongly recommended
• For stages 2, 3, 4 debulking surgery is necessary with intraperitoneal chemotherapy as well

Question 9

What are the types of hysterectomies available?

Answer 9

• Radical hysterectomy: EVERYTHING removed including uterus, cervix and upper vagina
• Total hysterectomy: uterus and cervix
• Sub-total hysterectomy: uterus only (keep cervix)
• Salpingectomy: fallopian tube removal
• Oophorectomy: ovaries removal

Question 10

Anatomical structures to be aware of during surgery:

Answer 10

• Rectum posteriorly: lead to perforation and consequent peritonitis
• Bladder anteriorly: lead to postop fistula formation
• Uretero-abdominal fistula formation if ureters are damaged during hysterectomy

Question 11

What is Risk of Malignancy Index (RMI)?

Answer 11

It is one of the widely used risk assessment for ovarian cancer.
It is comprised of:

U/S findings of pelvic mass
Menopausal status
Serum CA125 levels