Ovarian Cancer

Question 1

what are the 3 main pathological groups in ovary?

Answer 1

cysts

endometriosis

tumours

Question 2

what is a follicular cyst and how does it form?

Answer 2

very common cyst which forms when ovulation doesnt occur (polycystic ovaries) = follicle doesnt rupture but grows until it becomes a cyst

it is thin walled, lined by granulosa cells and usually resolves over a few months

Question 3

what is endometriosis?

Answer 3

presence of endometrial glands and stroma outside the uterine body

Question 4

what 3 things may endometriosis cause?

Answer 4

pelvic inflammation

infertility

pain

Question 5

what are the different common sites of endometriosis?

Answer 5

ovary (chocolate cyst)

pouch of douglas

peritoneal surfaces, including uterus

cervix, vulva, vagina

bladder, bowel etc

Question 6

what is the pathogenesis, macroscopic appearance and microscopic appearance of ovarian endometriosis?

Answer 6

pathogenesis = regurgitation, metaplasia, vascular or lymphatic dissemination

macroscopic = peritoneal spots or nodules, fibrous adhesions, chocolate cysts

microscopic = endometrial glands and stroma, haemorrhage, inflammation and fibrosis

Question 7

what are the complications of endometriosis?

Answer 7

pain

cyst formation

adhesions

infertility

ectopic pregnancy

malignancy (endometrioid carcinoma)

Question 8

how can ovarian tumours be classified?

Answer 8

epithelial

germ cell

sex-cord / stromal

metastatic

miscellaneous

Question 9

what are the different types of epithelial ovarian tumours (65-70% of ovarian tumours)?

Answer 9

serous

mucinous

endometrioid

clear cell

brenner

undifferentiated carcinoma

Question 10

epithelial ovarian tumours can be categorised as benign, borderline or malignant - what is the difference between each of these?

Answer 10

benign - no cytological abnormaliites, proliferative activity absent or scant, no stromal invasion

borderline - cytological abnormalities, proliferative, no stromal invasion

malignant - stromal invasion

Question 11

serous carcinoma has two distinct entities with different precursor lesions - what are these?

Answer 11

high grade serous carcinoma = from serous tubal intraepithelial carcinoma (STIC)

low grade serous carcinoma = from serous borderline tumour

Question 12

endometrioid and clear cell carcinoma have a strong association with what?

Answer 12

endometriosis of the ovary

*also association with lynch syndrome

Question 13

most endometrioid carcinomas are high grade and at late stage - true or false?

Answer 13

false - usually low grade and early stage

Question 14

how are ovarian tumours primarily diagnosed?

Answer 14

primary diagnosis often made on ascitic fluid

Question 15

what is a brenner tumour?

Answer 15

a tumour of transitional type epithelium which is usually benign

borderline and malignant variants are rare

Question 16

germ cell tumours make up what % of all ovarian tumours and what are they?

Answer 16

15-20%

teratoma

mature (benign, cystic) - dermoid cyst (95% of germ cells - contain hair etc)

Question 17

other then teratoma and dermoid cyst, give examples of other germ cell tumours?

Answer 17

immature teratoma

dysgerminoma

yolk sac tumour

choriocarcinoma

mixed germ cell tumour

Question 18

what is a dysgerminoma and who do they occur in?

Answer 18

most common malignant primitive germ cell tumour

1-2% of all malignant ovarian tumours

almost exclusivey children and young women, average age 22

Question 19

what are the 3 different kinds of sex cord / stromal tumours?

Answer 19

fibroma / thecoma = benign, may produce oestrogen causing uterine bleeding

granulosa cell tumour = all are potentially malignant, may be associated with oestrogenic manifestations

sertoli-leydig cell tumours = rare, may produce androgens

Question 20

where are the commonest places from ovary metastatic tumours to come from?

Answer 20

stomach, colon, breast, pancreas

*metastatic tumours must be considered in all cases, particularly when tumours are bilateral and small

Question 21

what are the different stages in ovarian cancer?

Answer 21

1A = tumour limited to one ovary

1B = tumour limited to both ovaries

1C = cancer involving ovarian surface / rupture / surgical spill / tumour in washings

2A = extension or implants on uterus / fallopian tube

2B = extension to other pelvic intraperitoneal organs

3A = retroperitoneal lymph node mets or microscopic extrapelvic peritoneal involvement

3B = macroscopic peritoneal mets beyond pelvis up to 2cm in dimension

3C = macroscopic peritoneal mets >2cm

4 = distant mets

Question 22

what different problems can occur within the fallopian tubes?

Answer 22

inflammation - salpingitis due to infection

cysts and tumours

serous tubal intraepithelial carcinoma

endometriosis

ectopic pregnancy

Question 23

what does salpingitis look like histologically?

Answer 23

Question 24

what must you consier in any female of reproductive age with amennorhoea and acute hypotension or an acute abdomen?

Answer 24

ectopic pregnancy - can rupture and cause fatal haemorrhage