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Obstetrics and gynaecology > Ovarian cysts and tumours > Flashcards

Ovarian cysts and tumours Flashcards

1
Q

What is an ovarian cyst?

A

Fluid filled sac in the ovary

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2
Q

When are ovarian cysts common?

A

Premenopausal patients - physiological cysts predominate throughout the menstrual cycle

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3
Q

What tool is used in practice to determine the likelihhod of malignancy and allow triage and referral to cancer centre for treatment

A

The risk of malignancy index

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4
Q

List the risk factors for ovarian cancer

A 
Nulliparity 
Early menarche
Late menopause
Oestrogen only HRT
Smoking
Obesity  
Genetics - BRCA1/2, HNPCC (Lynch 2 syndrome)
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5
Q

What are some protective factors of ovarian cancer

A

Multiparity
Combined contraceptive methods
Breastfeeding

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6
Q

Describe the BRCA1/2 mutations

A

Increase risk of breast/ovarian cancers

Ovarian cancer risk - 46% at age 70 in BRCA1 positive families and 12% in BRCA2 positive

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7
Q

Describe hereditary nonpolyposis colorectal cancer (Lynch 2 syndrome)

A

Rare syndrome with associated increased risk of developing colorectal and endometrial cancers
Confers a lifetime risk of developing ovarian cancer of 12%

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8
Q

Describe the risk of malignancy index

A 
RMI = U X M X CA125
M = Menopausal status - premenopausal (1), post menopausal (3)

U = ultrasound score - Mulilocular cyst, solid areas, metastases, ascites, bilateral lesions - No features (0), 1 feature (1), 2 or more features (3)

CA125 - cancer antigen 125 - measured from a blood test, giving a value in units/ml

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9
Q

What would a RMI be for a postmenopausal lady with a CA125 of 100 and bilateral lesions with solid areas on US have?

A

900

3x3x100

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10
Q

At what RMI should patients be referred to a gynaecologist

A

> 250

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11
Q

Describe the common presentations of ovarian cysts and tumours

A

Incidental/asymptomatic
Chronic pain
Acute pain
Bleeding per vagina

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12
Q

When taking a history of suspected ovarian cancer what should you enquire about

A 
Bloating 
Change in bowel habit
Change in urinary frequency 
Weight loss 
IBS
Bleeding per vagina
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13
Q

Describe the examination of someone with suspected pelvic mass

A

Resusictate any shocked patient presenting with ruptured cyst or torsion
Abdominal masses arising from pelvis
Ascites
Pelvis - bleeding or discharge or adnexal masses and cervical excitation

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14
Q

What can ovarian tumour be divided into?

A

Non-neoplastic

Neoplastic

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15
Q

What is a simple ovarian cyst?

A

One that contains fluid only

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16
Q

What is a complex ovarian cyst

A

Irregular and can contain solid material, blood or have septations or vascularity

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17
Q

Name some functional non neoplastic cysts

A

Follicular cysts

Corpus luteal cysts

18
Q

Name some pathological non-neoplastic cysts

A

Endometrioma
Polycystic ovaries
Theca lutein cyst

19
Q

Name some benign neoplastic epithelial tumours

A

Serous cystadenoma
Mucinous cystadenoma
Brenner tumour

20
Q

Name some benign germ cell tumours

A

Mature cystic teratoma (dermoid cysts)

21
Q

Name some sex-cord stromal tumours

A

Fibroma

22
Q

Describe functional cysts

A

<3cm

Represent the developing follicles in first half of menstrual cycle

23
Q

Describe corpus luteal cysts

A

<5cm

Occur in luteal phase of the menstrual cycle after formation of the corpus luteum

24
Q

Describe endometrioma

A

Chocolate cysts
Present in those with endometriosis
Bleeding into the cyst

25
Q

Describe polycystic ovaries

A

USS diagnosis
Ovaries contain >12 antral follicles or ovarian volume >10ml
Ring of pearls sign is seen on USS
PCO is present as one of the features of PCOS but isolated PCO does not equate to PCOS

26
Q

Describe theca lutein cyst

A

Result as a consequence of markedly raised hCG

Regress upon resolution of the raised hCG

27
Q

Describe serous cystadenoma

A

Reflects most common type of malignant tumour and is usually unilocular with up to 30% being bilateral

28
Q

Describe mucinous cystadenoma

A

Multiloculate and usually unilateral

29
Q

Describe Brenner tumour

A

Unilateral with solid grey or yellow appearance

30
Q

Describe mature cystic teratoma (dermoid cysts)

A

10% bilateral
Usually occur in young women and occur frequently in pregnancy
As germ cell in origin can contain hair, teeth, skin and bone

31
Q

Describe fibroma

A

Most common stromal tumour

40% present with Meigs syndrome

32
Q

What is Meigs syndrome?

A

Association between fibromas and ascites/pleural effusions

33
Q

Describe the management of ovarian masses in premenopausal women?

A

CA125 does not need to be undertaken when diagnosis of simple ovarian cyst has been made ultrasonographically

Lactate dehydrogenase, alpha-fetoprotein and hCG should be measured in all women <40 yrs due to possibility of germ cell tumour

Rescan cyst in 6 weeks - if persitent then monitor with USS and CA125 6-monthly and calculate RMI

If persistent or >5cm consider laparoscopic cystectomy or oophorectomy

34
Q

What can CA125 be raised by?

A

Anything which irritates the peritoneum - in premenopausal there are multiple benign triggers for an increase

35
Q

Describe the management of ovarian masses in post menopausal women

A

Low RMI (<25) - follow up for 1 yr with US and CA125 if <5cm

Moderate RMI (25-250) - bilateral oophorectomy and if malignancy found then staging is required - completion surgery of hysterectomy, omentectomy +/- lymphadenectomy

High RMI (over 250) - referral for staging laparotomy

36
Q

When do most patients with ovarian cancer present?

A

At a late stage due to non-specific symptoms

37
Q

Name two types of ovarian cancer

A

Epithelial subtypes:

  • Serous cystadenocarcinoma
  • Mucinous cystadenocarcinoma
38
Q

What are serous cystadenocarcinomas characterised by?

A

Psammoma bodies

39
Q

What are mucinous cystadenocarcinomas characterised by?

A

Mucin vacuoles

40
Q

What investigations should patients with ovarian cancer have?

A 
Bloods - FBC, U&E, LFT, albumin 
Imaging - Abdominal and pelvic USS 
RMI
CXR
CT AP - staging and pre-op purposes in diagnosed cancer
41
Q

Describe the management of ovarian cancer

A

Surgery
Adjuvant chemotherapy
Follow up

42
Q

Describe the triad for Meig’s syndrome

A

Ovarian fibroma
Pleural effusion
Ascites

Obstetrics and gynaecology (67 decks)

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