Ovarian Cysts And Masses Flashcards
Tumour marker for ovarian cancer
Ca125
Differential functional benign ovarian cyst? (3)
- 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. )
Management benign /simple ovarian cysts?
Follow up in different part cycle to see if regressed /change in size.
Most physiological with no intervention needed
What use to classify adnexal lesions? (2)
- iota LR2
- iota simple rules
How describe adnexal lesions by morphology? (4)
Cyst
- septum: complete/ incomplete
- solid papillary projections: smooth/ irregular
- internal wall: smooth or irregular
Solid tumour
- outer wall: smooth /irregular
How classify adnexal lesions (6)
Cystic
- unilocular cyst
- unilocular solid cyst (any solid component within)
- multilocular
- multilocular solid
Solid tumour: solid components 80 % or more of mass
Not classifiable
Name 5 factors suggestive of inherited BRCA gene mutation
- Early onset disease
- > 1 primary in 1 individual
- multiple cases
- all generations affected
- unusual cancers eg pancreatic
Name 4 big groups of ovarian cysts and masses for differential
- Functional benign cysts of ovary
- nonfunctional benign cysts of ovary
- tumour like conditions of ovary
- ovarian neoplasms
Name + describe 5 types nonfunctional benign cysts of the ovary
- 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)
Name + describe 2 types tumour-like conditions of the ovary
- Pregnancy luteoma
- massive edema of the ovary: usually unilateral
Name 9 types ovarian neoplasms
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
FIGO staging ovarian cancer stage 1?
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
FIGO staging ovarian cancer stage 2?
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
FIGO staging ovarian cancer stage 3?
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
FIGO staging ovarian cancer stage 4?
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
Management stage 1 ovarian cancer?
- Surgery for diagnosis and full staging to exclude spread to draining nodes, omentum and peritoneum
- oophorectomy
No benefit from chemo.
Management stage 2 ovarian cancer?
- 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
Management stage 4 ovarian cancer?
Initiate treatment with chemo. Surgery depends on response. May do optimal/ interval cytoreduction.
Management stage 3 ovarian cancer?
- 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
Diagnosis PCOS? (3)
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.
Differential anovulation and hyperandrogenism? (4)
- PCOS
- congenital adrenal hyperplasia
- androgen secreting tumours
- Cushing syndrome
PCOS pathophysiology? (4)
- 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
Symptoms PCOS? (8)
- 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
Long term implications PCOS? (3)
- 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
Diagnosis metabolic syndrome? (5)
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.
How does FSH help determine cause of amenorrhoea
FSH > 15 in young woman - suspect premature ovarian failure
Low FSH - suggests pituitary/hypothalamic cause
