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Gynaecology > Ovarian Cysts And Masses > Flashcards

Ovarian Cysts And Masses Flashcards

1
Q

Tumour marker for ovarian cancer

A

Ca125

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2
Q

Differential functional benign ovarian cyst? (3)

A
  • Follicular cyst: solitary smooth cyst in premenopausal woman (physiological cyst) (follow up at different point in cycle if pelvic pain , doesn’t usually cause pain )
  • theca lutein cysts: muticystic. response to HCG stimulation. May be associated with hydatidiform mole, or may follow induction ovulation.
  • corpus luteum cyst: (can cause pain, treat symptomatically , follow up. )
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3
Q

Management benign /simple ovarian cysts?

A

Follow up in different part cycle to see if regressed /change in size.
Most physiological with no intervention needed

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4
Q

What use to classify adnexal lesions? (2)

A
  • iota LR2
  • iota simple rules
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5
Q

How describe adnexal lesions by morphology? (4)

A

Cyst
- septum: complete/ incomplete
- solid papillary projections: smooth/ irregular
- internal wall: smooth or irregular

Solid tumour
- outer wall: smooth /irregular

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6
Q

How classify adnexal lesions (6)

A

Cystic
- unilocular cyst
- unilocular solid cyst (any solid component within)
- multilocular
- multilocular solid

Solid tumour: solid components 80 % or more of mass

Not classifiable

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7
Q

Name 5 factors suggestive of inherited BRCA gene mutation

A
  • Early onset disease
  • > 1 primary in 1 individual
  • multiple cases
  • all generations affected
  • unusual cancers eg pancreatic
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8
Q

Name 4 big groups of ovarian cysts and masses for differential

A
  • Functional benign cysts of ovary
  • nonfunctional benign cysts of ovary
  • tumour like conditions of ovary
  • ovarian neoplasms
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9
Q

Name + describe 5 types nonfunctional benign cysts of the ovary

A
  • endometrioma: endometriosis (hypoechoic) or mucinous cystadenoma
  • PCOS and hyperthecosis
  • para-ovarian / paratubal cysts: from embryological remnants of wolffian or mullerian duct within the 2 layers of the broad ligament
  • residual ovary syndrome: ovary may be stuck to vaginal vault or peritoneal surface after hysterectomy, be partly enclosed by adhesions, and cysts + pseudocysts may form with ovulation
  • ovarian remnant syndrome: ovarian tissue after presumed bilateral oophorectomy
  • tubO - ovarian abscess (from pid)
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10
Q

Name + describe 2 types tumour-like conditions of the ovary

A
  • Pregnancy luteoma
  • massive edema of the ovary: usually unilateral
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11
Q

Name 9 types ovarian neoplasms

A

Benign tumours
- epithelial:
→ serous + mucinous cystadenomas
→ Brenner tumour (post menopause)
- germ cell: mature cystic teratoma (ovarian dermoid cysts)
- Stromal / mesenchymal:
→ ovarian thecoma (postmenopause, can secrete oestrogen)
→ ovarian fibrosis (secrete collagen, look like fibroids)

Malignant
- stromal ( all ages)
- metastatic
- epithelial (most common, older women)
- germ cell

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12
Q

FIGO staging ovarian cancer stage 1?

A

limited to ovaries

  • 1 a: 1 ovary only, capsule intact, no tumour on external surface
  • 1 b: both ovaries, capsule intact, no tumour on external surface
  • 1 c: 1 a or b plus:
    → 1 c 1: surgical spill
    → 1 C 2: capsule rupture before surgery, or tumor on ovarian surface
    → 1 C 3: malignant cells in ascites or peritoneal washings
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13
Q

FIGO staging ovarian cancer stage 2?

A

With Pelvic extension below pelvic brim, or primary peritoneal cancer.

  • 2 a: extension to and/or implants on uterus / fallopian tubes
  • 2 b: extend to other pelvic intraperitoneal tissues
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14
Q

FIGO staging ovarian cancer stage 3?

A

With cytologically / histologically confirmed spread to peritoneum outside pelvis, and or metastasis to retroperitoneal lymph nodes

  • 3a:
    → 3a 1: positive retroperitional lymph nodes
    > 3a 1 i: metastasis 10 mm or less
    > 3a 1 ii: metastasis >10 mm
    → 3 a 2: microscopic, extrapelvic (above brim) peritoneal involvement +/- positive retroperitoneal lymph nodes
  • 3b: macroscopic, extra pelvic, peritoneal metastasis 2 cm or less +/- positive retroperitoneal lymph nodes; includes extension to capsule of liver / spleen.
  • 3c: macroscopic, extrapelvic, peritoneal metastasis >2 cm; and same as 3 b
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15
Q

FIGO staging ovarian cancer stage 4?

A

Distant metastasis excluding peritoneal

  • 4a: pleural effusion with positive cytology
  • 4b: hepatic and/or parenchymal metastasis, mets to extraabdominal organs incl inguinal lymph nodes and nodes outside abdominal cavity
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16
Q

Management stage 1 ovarian cancer?

A
  • Surgery for diagnosis and full staging to exclude spread to draining nodes, omentum and peritoneum
  • oophorectomy

No benefit from chemo.

17
Q

Management stage 2 ovarian cancer?

A
  • Surgery for diagnosis and full staging to exclude spread to draining nodes, omentum and peritoneum ( cytology, biopsy)
  • complete cytoreduction best (remove all visible disease) with 6 cycles adjuvant chemo or
  • optimal cytoreduction (remove all disease >1cm), plus adjuvant chemotherapy
18
Q

Management stage 4 ovarian cancer?

A

Initiate treatment with chemo. Surgery depends on response. May do optimal/ interval cytoreduction.

19
Q

Management stage 3 ovarian cancer?

A
  • complete cytoreduction best (remove all visible disease) with 6 cycles adjuvant chemo or
  • optimal cytoreduction (remove all disease >1cm), plus adjuvant chemotherapy
  • if cytoreduction will be or was suboptimal, do interval cytoreduction. If this is planned, do 3 chemo cycles
20
Q

Diagnosis PCOS? (3)

A

Rotterdam criteria 2 of 3:
- Infrequent ovulation/anovulation
- clinical and or biochemical hyperandrogenism
- PCOS morphology on ultrasound

Not applicable to teens bc all normal featuresof adolescence. To diagnose in < 20 years who are > 2 years after menarche , only diagnose if menstrual irregularity and clinical/biochemical hyper androgens. Ultrasound not done.

21
Q

Differential anovulation and hyperandrogenism? (4)

A
  • PCOS
  • congenital adrenal hyperplasia
  • androgen secreting tumours
  • Cushing syndrome
22
Q

PCOS pathophysiology? (4)

A
  • Excessive androgen secretion
  • contributed by intrinsic ovarian factors eg altered steroidogenesis
  • and external factors eg hyperinsulinaemia
  • this stimulates growth of small follicles, hinder follicular maturation and ovulation, hinder oestrogen and progesterone synthesis, inhibit aromatase activity and alter body composition
23
Q

Symptoms PCOS? (8)

A
  • Irregular menstrual cycles
  • secondary amenorrhoea
  • Infertility
  • Excessive hair growth esp on face, chest, back, buttocks
  • acne/oily skin
  • progressive hair loss
  • weight gain
  • anxiety and depression
24
Q

Long term implications PCOS? (3)

A
  • Endometrial hyperplasia→ cancer (due to chronic anovulation, lack progesterone, altered gene expression in endometrium,)
  • pregnancy complications: pre-eclampsia, gestational diabetes, late for gestational age babies
  • metabolic syndrome: obesity, hyper lipidemia, ht, diabetes
25
Q

Diagnosis metabolic syndrome? (5)

A

At least 3:

  • abdominal obesity with waist circumference > 88 cm
  • triglycerides 1,8 mmol/l or more
  • HDL < 1,3
  • bp 130/85 or more
  • fasting glucose 6-7, 2 hour OGTT 7,8 - 11,1 mmo/l

Screen annually.

Gynaecology (40 decks)

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