Ovarian cysts

Question 1

reproductive age woman - what makes a cyst worrying

Answer 1

bigger than 5cm
USS suspicious
symptomatic

Question 2

presentation of an ovarian cyst

Answer 2

asymptomatic
chronic dull ache
dyspareunia
cyclic pain

acute pain if bleeding into cyst, torsion or rupture

hormonal effeects
abdominal mass/swelling
ascites (think cancer)
symptoms from pressure on bladder/rectum

Question 3

ovarian torsion presentation

Answer 3

severe lower abdominal pain
vomiting
pain improves after 24hr when ovary starts to die

increased WCC and CRP

Question 4

functional cysts overview

Answer 4

enlarged follicular cysts - where dominant follicle doesnt rupture
enlarged corpus luteum cyst - doesnt break down

may cause pain if ruptures

endometrioma = chocolate cyst, an ovarian cyst filled with blood

Question 5

mucinous cystadenoma

Answer 5

in 30-50s
can be very big
filled with mucinous stuff

rupture can cause pseudomyxoma peritonei

Question 6

teratoma

Answer 6

dermoid cyst - benign mature teratoma
more common in young women

may contain teeth/hair

Question 7

fibroma

Answer 7

small solid benign fibrous tissue tumour
PV bleeding
pelvic pain
infertility/miscarriage

Rx - GnRH analogue to shrink then surgery

Question 8

RMI - risk of malignancy index

Answer 8

USS x menpause (y=3 n=1) x [CA125]

Question 9

investigation of ovarian cyst

Answer 9

TVS

RMI score if over 40

Question 10

ovarian cancer risks/protective factors

Answer 10

75-84
no kids, early periods, late menopause
BRCA genes. HNPCC

protective:
pregnancy, breastfeeding
COCP
tubal ligation

Question 11

ovarian cancer presentation

Answer 11

IBS picture
bloating, weight loss
tired
frequency/urgency
bowel habit change
pain
PV bleeding
mass in pelvis