Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

O&G > Ovarian Disorders > Flashcards

Ovarian Disorders Flashcards

1
Q

Outline the two major anatomical subdivisions of the ovary and what is found in each structure

A

Inner medulla and outer cortex

Medulla
- Blood vessels, connective tissue

Cortex

  • Covered by germinal epithelium
  • Contains follicles and theca cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Outline 5 different groups of ovarian cysts

A 
Functional
Inflammatory
Epithelial
Germ cell
Sex cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define ovarian cyst

A

Fluid filled sac in ovarian tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Outline types of functional ovarian cysts and describe their aetiology, including protective factors for their development

A

Follicular and luteal cysts

  • Persistently enlarged follicles and corpus lutea respectively
  • Diagnosed when cyst measures >3cm

Haemorrhagic cyst
- Bleeding into a functional cyst

Protective:
- COCP reduces risk of functional cysts by inhibiting ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the management of functional ovarian cysts

A

Asymptomatic:
- Reassurance and repeat USS arranged

Symptomatic (mainly pain, and for luteal cysts)
- Laparoscopic cystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Outline a type of inflammatory ovarian cyst, and describe its appearance

A

Endometriotic cysts (endometrioma)

  • Endometriosis causing accumulation of blood
  • ‘Chocolate cysts,’ with characteristic ground glass appearance on USS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Outline different types of epithelial ovarian tumours/cysts

A

They are derived from epithelium covering the ovary

Serous cystadenoma
- Its malignant variety is the most common malignant ovarian tumour

Mucinous cystadenoma
- Typically very large

Clear cell carcinoma
- Malignant variety

Endometroid carcinoma

  • Malignant variant of epithelial tumour
  • Histologically similar to endometrial carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe different types of germ cell tumour and their management

A

These are the most common ovarian tumours in young women (20-40)

Dermoid cyst

  • Contains tissue of all cell lines, commonly hair and teeth
  • Commonly benign

Yolk sac tumours
- Highly malignant

Management
- Ovarian cystectomy
Dermoid is unlikely to resolve on its own and can progress to torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Outline the cellular make up of sex cord ovarian tumours, describe different types of these tumours and how they can present

A

These tumours are composed of stromal cells

Granulosa cell tumours

  • Usually found in post-menopausal women
  • Secrete high levels of oestrogen and inhibin –> stimulating endometrium –> bleeding, endometrial hyperplasia/malignancy

Fibromas
- Can cause Meigs’ syndrome (ascites, right pleural effusion + small ovarian mass)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some complications of ovarian cysts?

A

Rupture, haemorrhage into the cyst, torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the clinical presentation of ovarian cysts

A

Depends on subtype, but can present with:

  • Lower abdominal pain
  • Deep dyspareunia
  • Iliac fossa pain + vomiting (torsion)
  • PV bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe what can be found in examination of an ovarian cysts

A

Abdominal
▪ Iliac fossa tenderness
▪ Rebound or guarding with acute accident

Vaginal
▪ Adnexal tenderness, palpable mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Outline some investigations for ovarian cysts

A
  • Acute presentation – exclude pregnancy
  • TVUSS
  • Bloods – FBC, GS, tumour markers (Ca 125, HCG, AFP), inhibin
  • Doppler US
  • Consider CT, MRI, laparoscopic investigation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the most common histological types of ovarian cancer?

A

Epithelial tumours account for 95% of ovarian tumours:

  • Serous adenocarcinoma (most common)
  • Endometroid, clear cell, mucinous

Non-epithelial:
- Germ cell most common in young women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Outline risk and protective factors for developing ovarian cancer

A

Risk is in relation to the number of ovulations

RFs:

  • Early menarche, late menopause
  • Nulliparity
  • Genetics: BRCA1, BRCA2 genes, HNPCC mutations

Protective:

  • Pregnancy, lactation
  • COCP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Outline some symptoms of ovarian cancer

A

Symptoms are often vague, hence why ovarian cancer presents late. Often symptoms are similar to IBS

  • Persistent abdominal distention (bloating)
  • Early satiety (feeling full)
  • Loss of appetite
  • Increased urinary frequency/urgency
  • PV bleeding
  • Breast and GI cancer symptoms (primary malignancy)
17
Q

Describe signs of ovarian cancer on examination

A

General
▪ Signs of malignancy –anaemia, cachexia

Chest
▪ signs of mets – pleural effusion (rarely leave perineum)

Abdo
▪ mass, ascites, hepatomegaly

Pelvic mass

Breast lump (primary malignancy)

18
Q

Where does ovarian cancer commonly spread and describe what type of staging is defined by FIGO

A
  • Spreads directly within pelvis and abdomen
  • Rarely can spread further (lungs, liver)

Staging is surgical and histological

19
Q

Outline the FIGO staging of ovarian cancer (Stages 1-4)

A

Stage 1: macroscopically confined to the ovaries

  • 1a: one ovary, capsule intact
  • 1b: two ovaries, capsule intact
  • 1c: 1a or 1b, ruptures capsule

Stage 2: extending to the pelvis
- Uterus, fallopian tubes, other pelvic tissues

Stage 3: abdominal spread and/or positive LN
- Omentum, small bowel, peritoneum

Stage 4: beyond abdomen
- Distant mets: e.g lungs, liver

20
Q

Outline the initial investigations for ovarian cancer which can be done in primary care

A

If suspicion of ovarian cancer:

  • Bloods: FBC (anaemia), U&E (ureteric obstruction, renal failure), LFTs (mets, low albumin) tumour marker Ca-125 (do AFP and hCG in younger women - these would be raised in germ cell tumours)
  • If Ca-125 is raised (>35IU/mL) –> USS of abdomen and pelvis
  • If USS identifies ascites or mass –> urgent referral to secondary care
21
Q

Describe further investigations of ovarian cancer that can be done in secondary care

A
  • RMI (risk of malignancy index) calculation (if score >250, refer to specialist MDT)
  • CT pelvis and abdomen
22
Q

Explain the components of RMI score

A

3 components: (U): ultrasound score, (M): menopausal status, and serum Ca 125 level

  • RMI = U x M x Ca 125

U (scored between 0 and 3)

  • Characteristics: multilcular cysts, solid areas, mets, ascites, bilateral lesions
  • None of the above, U=0, 1 of the above U=1, between 2-5 of the above, U=3

M
- 1=premenopausal, 3=postmenopausal

23
Q

Describe the management for ovarian cancer

A

Surgical

  • Aims to stage disease and remove all visible tumour
  • Laparotomy: total abdominal hysterectomy + bilateral salpingo-oopherectomy + omentectomy + biopsies of peritoneum, retroperitoneal LN
  • Further debunking may be required: bowel resection, peritoneal stripping, splenectomy
  • Fertility sparing surgery (young, borderline disease): non affected ovary preserved –> with very close monitoring

Chemotherapy

  • Platinum based (carboplatin), following surgery
  • Other chemo: paclitaxel, bevacizumab
  • Chemo can be given as primary therapy or neoadjuvant if surgery is not suitable
24
Q

Describe the follow up and prognosis of ovarian cancer management

A

Follow up:

  • Ca-125
  • CT
  • May require second look laparotomy to look at extent of residual disease

Prognosis dependent on:

  • Extent of cytoreduction following initial surgery, stage, histological grade
  • 5-year survival = 46% (stage 1 = 90%; stage 3 = 30%)
  • Causes most deaths out of any gynaecological cancer (largely due to late presentation - 75% present in stages 3-4)

O&G (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions