Ovarian Cysts Flashcards
In what group of women are functional ovarians cysts very common?
Premenopausal women
Are cysts in premenopausal or postmenopausal women more concerning for malignancy?
Cysts in postmenopausal
In what instances may ovarian cysts present with acute pelvic pain?
- Ovarian torsion
- Haemorrhage of cyst
- Rupture of cyst
How do functional cysts appear on ultrasound?
Thin walls and no internal structures.
What are corpus luteum cysts?
When corpus luteum fails to break down and instead filled with fluid.
Can cause pelvic discomfort, pain or delayed menstruation.
Often seen in early pregnancy.
What is a serous cystadenoma?
Benign tumours of the epithelial cells
What is a mucinous cystadenoma?
Benign tumour of the epithelial cells. They can become huge, taking up lots of space in the pelvis and abdomen.
What is an endometrioma?
Lumps of endometrial tissue within the ovary, occurring in patients with endometriosis. They can cause pain and disrupt ovulation.
What are dermoid cysts/ germ cell tumours?
These are benign ovarian tumours.
They are teratomas, meaning they come from the germ cells and may contain various tissue types, such as skin, teeth, hair and bone.
They are particularly associated with ovarian torsion.
What is a sex cord-stromal tumour?
These are rare tumours, that can be benign or malignant. They arise from the stroma (connective tissue) or sex cords (embryonic structures associated with the follicles). There are several types, including Sertoli–Leydig cell tumours and granulosa cell tumours.
When managing ovarian cysts, what features suggest malignancy (8)?
- Abdominal bloating
- Reduce appetite
- Early satiety
- Weight loss
- Urinary symptoms
- Pain
- Ascites
- Lymphadenopathy
What are risk factors for ovarian malignancy (8)?
- Age
- Postmenopause
- Increased number of ovulations
- Obesity
- Hormone replacement therapy
- Smoking
- Breastfeeding (protective)
- Family history and BRCA1 and BRCA2 genes
What factors reduce the number of ovulations a women has during her life?
- Later onset of periods (menarche)
- Early menopause
- Any pregnancies
- Use of the combined contraceptive pill
What is the management of a premenopausal women with a simple ovarian cyst less than 5cm on ultrasound?
No need for further investigations
What is the tumour marker for epithelial cell ovarian cancer?
CA125
What blood tests are required for women under 40 with a complex ovarian mass requiring tumour markers for a possible germ cell tumour?
- Lactate dehydrogenase (LDH)
- Alpha-fetoprotein (a-FP)
- Human chorionic gonadotropin (HCG)
List non-malignant causes of a raised CA125 (6).
- Endometriosis
- Fibroids
- Adenomyosis
- Pelvic infection
- Liver disease
- Pregnancy
What three things does the risk of malignancy index (RMI) take into account?
- Menopausal status
- Ultrasound findings
- CA125 level
What is the management of 5cm to 7cm simple ovarian cysts in premenopausal women?
Require routine referral to gynaecology and yearly ultrasound monitoring
What is the management of 7cm+ simple ovarian cysts in premenopausal women?
Consider an MRI scan or surgical evaluation as they can be difficult to characterise with ultrasound
What is the management of a raised CA125 in a postmenopausal women?
2 week wait suspected referral
What is the triad of Meig’s syndrome?
- Ovarian fibroma (benign ovarian tumour)
- Pleural effusion
- Ascites
What age group does Meig’s syndrome typically occur in?
Older women.
How is Meig’s syndrome managed?
Removal of tumour results in complete resolution of the effusion and ascites.
