Ovarian Disorders Flashcards
Define ovarian cyst
Fluid filled sac within the ovary
- common esp premenopausal where benign, physiological cysts predominate
- risk of presence of malignancy
Risk factors for ovarian cancer
Surface epithelial irritation during ovulation
- nulliparity
- early menarche
- late menopause
- hormone replacement therapy containing oestrogen only
- smoking
- obesity
Genetic
- BRCA1 +2
- hereditary nonpolyposis colorectal cancer
Protective factors for ovarian cancer
Multiparity
COCP
Breastfeeding
Features of risk of malignancy index
Menopausal status - premenopausal = 1 - postmenopausal = 2 Ultrasound score - multilocular cyst, solid areas, metastases, ascites, bilateral lesions - 1 point for 1 feature - 2 points for 2 plus CA125 value
How is RMI calculated
RMI = U x M x CA125
> 250 referred to specialist
Clinical features of ovarian cysts/tumours
Asymptomatic and incidental
Chronic pain - pressure on bladder or bowel
Acute pain - bleeding, rupture or torsion
Bleeding per vagina
Bloating, change in bowel habit or urinary frequency, weight loos, IBS, bleeding per vagina
Classification of ovarian cysts
Simple - only contains fluid
Complex - irregular, contains solid material, blood, have septations or vascularity
Non-neoplastic
- functional
- follicular - normally less than 3cm, 1st half of cycle
- corpus luteal - less than 5cm, occur during luteal phase
- pathological
- endometrioma - chocolate cyst, present in endometriosis
- polycystic ovaries - contain more than 12 follicles, ring of pearls sign
- theca lutein cyst - result of markedly raised hCG eg molar pregnancy
Benign neoplastic
- epithelial
- serous cystadenoma - most common, usually unilocular
- mucinous cystadenoma - multioculated and unilateral
- brenner - unilateral with solid grey or yellow appearance
- benign germ cell
- mature cystic teratoma (Dermoid cysts) - mostly young women and pregnancy, contain teeth, hair, skin and bone
- sex-cord stromal tumours
- fibroma
Management of ovarian cysts/tumours
Premenopausal
- lactate dehydrogenase, alpha-fetoprotein and hCG due to possibility of germ cell tumours
- rescan cyst at 6 weeks - if persistent monitor with USS, CA125 3-6 monthly
- if persistent or over 5cm consider laparoscopic cystectomy or oophorectomy
Postmenopausal
- if RMI < 25 and < 5cm - follow up for 1 year with USS and CA125
- if RMI 25-250 - bilateral oophorectomy and if malignancy found then staging required
- completion surgery of hysterectomy, omentectomy +/- lymphadenectomy
- RMI > 250 refer for staging laparotomy
Types of ovarian cancer subtype
Serous cystadenocarcinoma
- characterised by Psammoma bodies - calcification
Mucinous cystadenocarcinoma
- characterised by mucin vacuoles
Management of ovarian cancer
Surgery
- staging laparotomy for those with high RMI
- attempt debulk tumour
Adjuvant chemo
- all apart from those with early, low grade disease
Follow up
- clinical exam and monitoring CA125 for 5 years
- intervals between visits become further apart
Define PCOS
Polycystic Ovary Syndrome
- endocrine disorder characterised by excess androgen and presence of multiple immature follicles in ovaries
Pathophysiology of PCOS
Excess LH
- produced by anterior pituitary in response to an increased GnRH pulse frequency
- stimulates ovarian production of androgens
Insulin resistance
- high levels of insulin secretion
- suppresses hepatic production of sex hormone binding globulin -> higher levels of free circulating androgens
Clinical features of PCOS
Oligomenorrhoea or amenorrhoea Infertility Hirsutism Obesity Chronic pelvic pain Depression
Differential diagnosis of PCOS
Hypothyroidism - obesity, hair loss and insulin resistance
Hyperprolactinaemia - oligo/amenorrhoea, acne and hirsutism
Cushing’s disease - obesity, acne, hypertension, insulin resistance, depression
Criteria for PCOS
Rotterdam criteria - must have 2 of the 3
- oligo and/or anovulation
- clinical and/or biochemical signs of hyperandrogenism
- polycystic ovaries on imaging
