Ovarian Cancer Flashcards
what are the 3 main pathological groups in ovary?
cysts
endometriosis
tumours
what is a follicular cyst and how does it form?
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
what is endometriosis?
presence of endometrial glands and stroma outside the uterine body
what 3 things may endometriosis cause?
pelvic inflammation
infertility
pain
what are the different common sites of endometriosis?
ovary (chocolate cyst)
pouch of douglas
peritoneal surfaces, including uterus
cervix, vulva, vagina
bladder, bowel etc
what is the pathogenesis, macroscopic appearance and microscopic appearance of ovarian endometriosis?
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
what are the complications of endometriosis?
pain
cyst formation
adhesions
infertility
ectopic pregnancy
malignancy (endometrioid carcinoma)
how can ovarian tumours be classified?
epithelial
germ cell
sex-cord / stromal
metastatic
miscellaneous
what are the different types of epithelial ovarian tumours (65-70% of ovarian tumours)?
serous
mucinous
endometrioid
clear cell
brenner
undifferentiated carcinoma
epithelial ovarian tumours can be categorised as benign, borderline or malignant - what is the difference between each of these?
benign - no cytological abnormaliites, proliferative activity absent or scant, no stromal invasion
borderline - cytological abnormalities, proliferative, no stromal invasion
malignant - stromal invasion
serous carcinoma has two distinct entities with different precursor lesions - what are these?
high grade serous carcinoma = from serous tubal intraepithelial carcinoma (STIC)
low grade serous carcinoma = from serous borderline tumour
endometrioid and clear cell carcinoma have a strong association with what?
endometriosis of the ovary
*also association with lynch syndrome
most endometrioid carcinomas are high grade and at late stage - true or false?
false - usually low grade and early stage
how are ovarian tumours primarily diagnosed?
primary diagnosis often made on ascitic fluid
what is a brenner tumour?
a tumour of transitional type epithelium which is usually benign
borderline and malignant variants are rare
germ cell tumours make up what % of all ovarian tumours and what are they?
15-20%
teratoma
mature (benign, cystic) - dermoid cyst (95% of germ cells - contain hair etc)
other then teratoma and dermoid cyst, give examples of other germ cell tumours?
immature teratoma
dysgerminoma
yolk sac tumour
choriocarcinoma
mixed germ cell tumour
what is a dysgerminoma and who do they occur in?
most common malignant primitive germ cell tumour
1-2% of all malignant ovarian tumours
almost exclusivey children and young women, average age 22
what are the 3 different kinds of sex cord / stromal tumours?
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
where are the commonest places from ovary metastatic tumours to come from?
stomach, colon, breast, pancreas
*metastatic tumours must be considered in all cases, particularly when tumours are bilateral and small
what are the different stages in ovarian cancer?
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
what different problems can occur within the fallopian tubes?
inflammation - salpingitis due to infection
cysts and tumours
serous tubal intraepithelial carcinoma
endometriosis
ectopic pregnancy
what does salpingitis look like histologically?
what must you consier in any female of reproductive age with amennorhoea and acute hypotension or an acute abdomen?
ectopic pregnancy - can rupture and cause fatal haemorrhage
