Ovarian Disorders Flashcards
What are the most common hormonal abnormalities in PCOS?
Excess LH –> stimulates ovarian production of androgens
Insulin resistance –> surpasses hepatic production of sex hormone binding globulin
What is the diagnostic criteria for PCOS?
2 out of 3 of the following:
- oligo and/or anovulation
- clinical or biochemical signs of hyperandrogenism
- polycystic ovaries on imaging
Which blood tests should be done to investigate PCOS and what will they show?
Testosterone - high SHBG - low LH - raised FSH - normal Progesterone - low
How is oligo/amenorrhoea managed in PCOS?
COCP
Dydrogesterone if pill contraindicated
(protects endometrial lining)
How is infertility treated in PCOS?
Clomifene +/- metformin to induce ovulation
Laparoscopic ovarian drilling in women with normal BMI
What are the risk factors for ovarian cancer?
Nulliparity Early menarche/late menopause Oestrogen only HRT Smoking Obesity BRCA 1 + 2 Lynch syndrome
Which factors are protective against ovarian cancer?
Multiparity
COCP
Breastfeeding
Which tool is used to risk stratify suspected ovarian cancer and what are the components?
Risk of Malignancy Index (RMI):
M = menopausal status
U = ultrasound score
CA125 = cancer antigen 125 blood test
RMI = M x U x CA125
How is menopausal status graded in the RMI?
1 = premenopausal 3 = postmenopausal
How is ultrasound score graded in the RMI?
Features:
- multilocular cyst
- solid areas
- metastases
- ascites
- bilateral lesions
No features = 0
1 features = 1
2 or more features = 3
How is the RMI interpreted?
RMI > 250 should be referred to gynae oncology
How might ovarian cancer present?
Incidental + asymptomatic (scanning for other reason)
Chronic pain
Acute pain e.g. bleeding, rupture or torsion
Vaginal bleeding
Which symptoms should be specifically enquired about to detect ovarian cancer?
Bloating Change in bowel habit Change in urinary frequency Weight loss IBS Vaginal bleeding
What are the different types of ovarian tumours?
Epithelial:
- serous
- mucinous
- endometrioid
- clear cell
Sex cord/stromal (rarer):
- granulosa cell
- thecoma/fibroma
- sertoli/leydig cell
Germ cell:
- teratoma
- dysgerminoma
- endodermal sinus or yolk sac
- choriocarcinoma
Metastases:
- endometrial
- breast
- pancreas
- GI
Which type of ovarian cancer is most common?
Serous tumours
What are the features of a teratoma?
Usually benign
If mature, may contain hair, teeth etc
If malignant (rare) produce HCG, AFP or thyroxine
Where does ovarian cancer tend to spread?
Peritoneal cavity
Para-aortic nodes
Which system is used to stage ovarian cancer?
FIGO system
What are the different stages of ovarian cancer?
1A - limited to one ovary 1B - limited to both ovaries 1C - involves surface of ovary/tumour in spill/washings 2A - uterus/fallopian tubes 2B - other pelvic/intraperitoneal 3A - retroperitoneal lymph node 3B - peritoneal mets beyond pelvis up to 2cm 3C - peritoneal mets > 2cm 4 - distant mets
What is the treatment for cervical cancer?
Usually combination of chemotherapy + surgery
Surgery along for stage 1A/B
Chemotherapy alone for those not fit for surgery
What is the surgery done for ovarian cancer?
TAH BSO + omentectomy
total abdominal hysterectomy + bilateral salpingoophrectomy
What are the features of simple and complex ovarian cysts?
Simple:
- fluid only
Complex:
- irregular, can contain solid material, blood or have separations
What are the types of functional ovarian cysts?
Follicular cysts
Corpus luteal cysts
What are the features of follicular cysts?
Normally less than 3cm
Developing follicle in first half of menstrual cycle
What are the features of corpus luteal cysts?
Normally < 5cm
Occur in luteal phase after formation of corpus luteum
What are the types of pathological, non-neoplastic cysts?
Endometrioma (chocolate cysts)
Polycystic ovaries
Theca lutein cyst
What are the features of polycystic ovaries?
Ovaries contain > 12 astral follicles, or ovarian volume > 10ml
Ring of pearls seen on USS
What causes theca lutein cysts?
Markedly raised hCG e.g. molar pregnancy
- they regress upon resolution of the raised hCG
What are the different types of benign ovarian cysts, that have the potential to become malignant?
Serous cystadenoma Mucinous cystadenoma Brenner tumour (solid grey or yellow appearance) Mature cystic teratoma (dermoid cyst) Fibroma
Which syndrome is associate with ovarian fibromas?
Meig’s syndorme
- ascites/pleural effusion
What is the management for ovarian cysts in premenopausal women?
Measure lactate dehydrogenase, AFP and hCG due to risk of germ cell tumours
Don’t need to measure CA125 if simple cyst on USS
Rescan in 6 weeks
- if persistent, monitor and calculate RMI
If persistent or >5cm consider cystectomy or oophorectomy
What is the management for ovarian cysts in postmenopausal women?
Low RMI –> follow up for 1 year if < 5cm
Moderate RMI –> bilateral oophorectomy, if malignancy found then staging + completion of surgery
High RMI –> referral for staging laparotomy
Which tumours are characterised by Psammoma bodies?
Serous cystadenocarcinomas (most common ovarian cancer)
How is ovarian cancer progression monitored?
CA125 level
