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REPRODUCTION & GYNAECOLOGY > Ovarian Cancer > Flashcards

Ovarian Cancer Flashcards

1
Q

What symptoms do ovarian pathology usually cause?

A
  • Pain
  • Swelling (pelvic mass)
  • Endocrine effects
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2
Q

Where can ovarian cysts arise from?

A

– Follicular e.g. polycystic ovaries
– Luteal
– Endometriotic (usually filled with blood)
– Epithelial (usually neoplastic => can be benign or malignant)
– Mesothelial

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3
Q

Describe the appearance and lining of a follicular cyst?

A 
Looks like a normal developing follicle
=> lined by granulosa cells
- doesn't rupture but  grows until it becomes a cyst
- will resolve over a few months
- can grow to several cms
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4
Q

When can follicular cysts normally develop?

A
  • when ovulation doesn’t occur

e. g. polycystic ovaries PCOS

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5
Q

What is endometriosis and what symptoms does it cause?

A
  • Endometrial glands and stroma outside the uterine body

- endometrial tissue sheds every month => causing Pelvic inflammation, Pain and sometimes Infertility

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6
Q

Name some of the common sites for endometriosis to occur?

A 
Ovary (‘chocolate’ cyst)
Pouch of Douglas
Peritoneal surfaces, including uterus
Cervix, vulva, vagina
Bladder, bowel etc
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7
Q

Why may endometriosis cause infertility?

A

If it occurs in the fallopian tube, can cause scarring
=> impairs passage of egg down the tube

this can also cause ectopic pregnancies

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8
Q

What theories are thought to explain the pathogenesis of endometriosis?

A
  • regurgitation of menstrual blood out of fallopian tubes
  • metaplasia of mesothelium tissue
  • vascular or lymphatic dissemination
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9
Q

How does ovarian endometriosis appear macroscopically?

A
  • Brown/black peritoneal spots or nodules
  • Fibrous adhesions on ovary
  • Chocolate cysts
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10
Q

How does ovarian endometriosis appear microscopically?

A

Endometrial glands and stroma seen

- haemorhage (due to endometrial bleeding), inflammation, fibrosis (scarring)

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11
Q

What are the potential complications of endometriosis?

A
  • Pain
  • Cyst formation
  • Adhesions
  • Infertility
  • Ectopic pregnancy
  • Malignancy (endometrioid carcinoma)
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12
Q

What makes clinicians more suspicious that a tumour is malignant?

A
  • cystic but with solid parts within

sold diffuse mass - more likely malignant

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13
Q

What are the different classifications of ovarian tumour?

A 
Epithelial (most common malignant)
Germ cell (e.g. teratoma)
Sex‐cord/stromal
Metastatic
Miscellaneous
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14
Q

Why are epithelial tumours thought to occur in the ovary if no epitheium is normally present?

A
  • ovary usually covered by mesothelium
  • when egg breaks through this at ovulation, mesothelium comes into contact with stroma
    => undergoes metaplasia
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15
Q

How can epithelial ovarian tumours be subdivided?

A

Benign
Borderline
Malignant

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16
Q

Describe the difference between benign borderline and malignant?

A

Benign - no abnormal cytology or proliferation

Borderline - abnormal cytology and proliferation BUT no invasion

Malignant - invasion

17
Q

It is possible for one tumour to contain benign, borderline and malignant tissue. TRUE/FALSE?

A

TRUE

18
Q

What is the precusor lesion to high grade serous ovarian carcinoma?

A

Serous tubal intraepithelial carcinoma (STIC)

=> tubal in origin

19
Q

What is the precursor lesion to low grade serous ovarian carcinoma?

A

Serous borderline tumour

20
Q

Describe the histological appearance of a high grade serous carcinoma?

A

nuclear pleomorphism

fused tumour cells

21
Q

What type of cancer is associated with endometriosis of the ovary? What other condition is this associated with?

A
  • Endometroid carcinoma

- also associated with Lynch syndrome

22
Q

Diagnosis of a cancer can be made from ascitic fluid. TRUE/FALSE?

A

TRUE

- especially if an ovarian biopsy is difficult to take

23
Q

Why is it important that ovarian cysts are removed completely intact?

A
  • if perforated and cells fall back into pelvis, these can cause further tumour growth after original cyst is removed
24
Q

A Brenner tumour originates from what type of epithelium?

A

Transitional type epithelium

usually found in bladder

25
Q

Are Brenner tumours usually benign or malignant?

A
  • Usually benign,

- borderline and malignant variants = rare

26
Q

What is the other name given to mature teratomas?

A

dermoid cyst

27
Q

Teratomas can become malignant. TRUE/FALSE?

A

TRUE (but very rare)

- usually because one of the types of tissue growing in the teratoma become malignant

28
Q

What types of tissue can teratomas contain?

A
  • germ cells in ovary are pluripotent => can differentiate into any type of cell
    – Often they are cystic, containing sebum and hair
    – Contain ALL of ecto, meso and endoderm
    – skin, respiratory epithelium, gut, fat common
29
Q

What other types of germ cell tumour can be found in the ovary?

A

Immature teratoma (cells like an embryo)
Dysgerminoma (homologous to seminoma in males)
Yolk sac tumour
Choriocarcinoma

30
Q

What sex-cord/stromal tumours can arise in the ovary?

A

Fibroma/Thecoma
Benign (may produce oestrogen => uterine bleeding)

Granulosa cell tumour

  • potentially malignant
  • associated with oestrogen

Sertoli-Leydig cell tumours
- Rare, may produce androgens

31
Q

Where do ovarian metastases potentially come from?

A

Stomach (most common - signet rings - Krukenberg’s)
Colon
Breast
Pancreas

32
Q

Describe how ovarian cancers are staged?

A

1 = confined to ovaries
2 = Extension or implants on uterus/fallopian tube/pelvic intraperitoneal
3 = local and lymph node metastases
4 Distant metastasis

33
Q

What pathologies can be found in the fallopian tubes?

A 
Inflammation
Salpingitis due to infection
Cysts and tumours
Serous tubal intraepithelial carcinoma (precursor to cancer)
Endometriosis
Ectopic pregnancy

REPRODUCTION & GYNAECOLOGY (58 decks)

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