Ovarian Cancer Flashcards
What symptoms do ovarian pathology usually cause?
- Pain
- Swelling (pelvic mass)
- Endocrine effects
Where can ovarian cysts arise from?
– Follicular e.g. polycystic ovaries
– Luteal
– Endometriotic (usually filled with blood)
– Epithelial (usually neoplastic => can be benign or malignant)
– Mesothelial
Describe the appearance and lining of a follicular cyst?
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
When can follicular cysts normally develop?
- when ovulation doesn’t occur
e. g. polycystic ovaries PCOS
What is endometriosis and what symptoms does it cause?
- Endometrial glands and stroma outside the uterine body
- endometrial tissue sheds every month => causing Pelvic inflammation, Pain and sometimes Infertility
Name some of the common sites for endometriosis to occur?
Ovary (‘chocolate’ cyst) Pouch of Douglas Peritoneal surfaces, including uterus Cervix, vulva, vagina Bladder, bowel etc
Why may endometriosis cause infertility?
If it occurs in the fallopian tube, can cause scarring
=> impairs passage of egg down the tube
this can also cause ectopic pregnancies
What theories are thought to explain the pathogenesis of endometriosis?
- regurgitation of menstrual blood out of fallopian tubes
- metaplasia of mesothelium tissue
- vascular or lymphatic dissemination
How does ovarian endometriosis appear macroscopically?
- Brown/black peritoneal spots or nodules
- Fibrous adhesions on ovary
- Chocolate cysts
How does ovarian endometriosis appear microscopically?
Endometrial glands and stroma seen
- haemorhage (due to endometrial bleeding), inflammation, fibrosis (scarring)
What are the potential complications of endometriosis?
- Pain
- Cyst formation
- Adhesions
- Infertility
- Ectopic pregnancy
- Malignancy (endometrioid carcinoma)
What makes clinicians more suspicious that a tumour is malignant?
- cystic but with solid parts within
sold diffuse mass - more likely malignant
What are the different classifications of ovarian tumour?
Epithelial (most common malignant) Germ cell (e.g. teratoma) Sex‐cord/stromal Metastatic Miscellaneous
Why are epithelial tumours thought to occur in the ovary if no epitheium is normally present?
- ovary usually covered by mesothelium
- when egg breaks through this at ovulation, mesothelium comes into contact with stroma
=> undergoes metaplasia
How can epithelial ovarian tumours be subdivided?
Benign
Borderline
Malignant
Describe the difference between benign borderline and malignant?
Benign - no abnormal cytology or proliferation
Borderline - abnormal cytology and proliferation BUT no invasion
Malignant - invasion
It is possible for one tumour to contain benign, borderline and malignant tissue. TRUE/FALSE?
TRUE
What is the precusor lesion to high grade serous ovarian carcinoma?
Serous tubal intraepithelial carcinoma (STIC)
=> tubal in origin
What is the precursor lesion to low grade serous ovarian carcinoma?
Serous borderline tumour
Describe the histological appearance of a high grade serous carcinoma?
nuclear pleomorphism
fused tumour cells
What type of cancer is associated with endometriosis of the ovary? What other condition is this associated with?
- Endometroid carcinoma
- also associated with Lynch syndrome
Diagnosis of a cancer can be made from ascitic fluid. TRUE/FALSE?
TRUE
- especially if an ovarian biopsy is difficult to take
Why is it important that ovarian cysts are removed completely intact?
- if perforated and cells fall back into pelvis, these can cause further tumour growth after original cyst is removed
A Brenner tumour originates from what type of epithelium?
Transitional type epithelium
usually found in bladder
Are Brenner tumours usually benign or malignant?
- Usually benign,
- borderline and malignant variants = rare
What is the other name given to mature teratomas?
dermoid cyst
Teratomas can become malignant. TRUE/FALSE?
TRUE (but very rare)
- usually because one of the types of tissue growing in the teratoma become malignant
What types of tissue can teratomas contain?
- 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
What other types of germ cell tumour can be found in the ovary?
Immature teratoma (cells like an embryo)
Dysgerminoma (homologous to seminoma in males)
Yolk sac tumour
Choriocarcinoma
What sex-cord/stromal tumours can arise in the ovary?
Fibroma/Thecoma
Benign (may produce oestrogen => uterine bleeding)
Granulosa cell tumour
- potentially malignant
- associated with oestrogen
Sertoli-Leydig cell tumours
- Rare, may produce androgens
Where do ovarian metastases potentially come from?
Stomach (most common - signet rings - Krukenberg’s)
Colon
Breast
Pancreas
Describe how ovarian cancers are staged?
1 = confined to ovaries
2 = Extension or implants on uterus/fallopian tube/pelvic intraperitoneal
3 = local and lymph node metastases
4 Distant metastasis
What pathologies can be found in the fallopian tubes?
Inflammation Salpingitis due to infection Cysts and tumours Serous tubal intraepithelial carcinoma (precursor to cancer) Endometriosis Ectopic pregnancy
