Ovarian DO

Question 1

What is the most common type of ovarian cyst? How does it present? How do you treat it?

Answer 1

Follicular cyst
Usually asymptomatic
Will usually resolve spontaneously!

Question 2

What causes a follicular cyst?

Answer 2

Failure of ovulation

Question 3

What type of cyst occurs after ovulation?

Answer 3

Corpus luteum cyst

Question 4

What type of cyst is a bilateral functional cyst that is greater than 3cm and usually occurs in pregnancy?

Answer 4

Theca-lutein cyst

Question 5

What level is high with a theca-lutein cyst? What does this put a patient at risk for?

Answer 5

B HCG

Risk multifetal gestations or molar pregnancy

Question 6

What is a molar pregnancy?

Answer 6

Non-viable fertilized egg implants into uterus

Question 7

What type of cyst will sometimes occur with endometriosis?

Answer 7

Hemorrhagic cyst

Question 8

What can occur if a patient has an ovarian cyst that is greater than 6cm?

Answer 8

Torsion of the cyst or ovary

Question 9

How do you manage a fluid-filled cyst?

Answer 9

Periodic US

Question 10

What is the most common method of removing a cyst?

Answer 10

Laparascopy

Question 11

How do you prevent ovarian cysts?

Answer 11

OCPs!

Question 12

How do you treat the pain of ovarian cysts?

Answer 12

NSAIDs

Question 13

When can you diagnose PCOS clinically?

Answer 13

2 out of 3 of the following

Oligo or amenorrhea and anovulation
Hyperandrogenism
Ultrasound: Evidence of polycystic ovaries

Question 14

What is the most common cause of infertility in women?

Answer 14

PCOS

Question 15

What are two things that can cause PCOS?

Answer 15

Insulin resistance

Unopposed estrogen

Question 16

How do you diagnose PCOS?

Answer 16

Diagnosis of exclusion!

Question 17

What do you want to exclude before you diagnose PCOS?

Answer 17

Nonclassic congenital adrenal hyperplasia
Cushing’s sydnrome
Ovarian and adrenal androgen-secreting tumors and ovarian hyperthecosis

Question 18

Who do you treat PCOS?

Answer 18

Treat unopposed estrogen and insulin resistance
OCPs
Cycle w/ progesterone
Metformin for insulin resistance
Clomiphene citrate for infertility

Question 19

What is an additional benefit of using metformin to treat insulin resistance?

Answer 19

May also improve fertility :)

Question 20

What should you do if you find an enlarging ovarian mass with a solid component or change in character?

Answer 20

REMOVE IT! Esp. in a postmenopausal woman

Question 21

Does screening for ovarian CA reduce mortality?

Answer 21

No! It is not recommended

Question 22

85-90% of ovarian cancer originates in the _____

Answer 22

Epithelium of the ovary

Question 23

What percentage of ovarian cancer is a germ cell tumor?

Answer 23

5-10%

Question 24

Where do germ cell tumors occur? Who is typically affected by these?

Answer 24

Cells that produce eggs

Typically women in their 20s

Question 25

What percentage of ovarian cancer is from stroma carcinoma tumors?

Answer 25

about 5%

Question 26

Clear cell ovarian carcinomas are _____ benign

Answer 26

Rarely

Question 27

What make up 40-50% of all benign ovarian neoplasms from totipotential germ cells?

Answer 27

Teratomas or dermoid cysts

Question 28

Who is more likely to have a malignant germ cell tumor?

Answer 28

Teenage girls :(

Question 29

Stromal tumors produce?

Answer 29

Hormones!

Question 30

What age puts a patient at an increased risk for ovarian cancer?

Answer 30

Over 65

Question 31

What is the most lethal gynecologic malignancy, often referred to as the "silent killer"?

Answer 31

Ovarian cancer

Question 32

When does the risk of ovarian cancer peak?

Answer 32

65-75

Question 33

What are the common symptoms of ovarian cancer? (8 total, shoot for 4!)

Answer 33

``` Pelvic pain Abdominal pain/fullness Indigestion Heartburn Back pain Feeling rapidly full post eating Urinary frequency Changes in bowel habits ```

Question 34

What are some symptoms associated with LATE STAGE ovarian cancer?

Answer 34

Abdominal pain/bloating Early satiety Urinary urgency/frequency

Question 35

What do you do if you find a palpable ovary in a postmenopausal woman?

Answer 35

Evaluate ASAP!

Question 36

Is an US a screening test for ovarian cancer?

Answer 36

NO

Question 37

Who should manage treatment of ovarian cancer?

Answer 37

Gynecologic oncologist

Question 38

Does a family history of ovarian cancer increase a woman's lifetime risk?

Answer 38

Only 2-6%

Question 39

What raises a woman lifetime risk of ovarian cancer to 25-50%?

Answer 39

Familial ovarian cancer syndrome (BRCA gene)

Question 40

If a patient has the BRCA gene, what should you do?

Answer 40

Prophylactic bilateral salpingo-oophorectomy by age 35 or as soon as childbearing is complete

Question 41

One last time, is screening recommended for ovarian cancer?

Answer 41

No! Screening has shown that the risks outweigh the benefits. Also, 98% of women screened as positive WILL NOT have ovarian cancer!

Question 42

How do you diagnose ovarian cancer?

Answer 42

Transvaginal US or laparoscopic evaluation

Question 43

How do you treat ovarian cancer?

Answer 43

Remove tumor with surgery - maybe a total hysterectomy Bilteral oophorectomy Chemotherapy Radiation - Not highly regarded in the treatment of ovarian cancer

Question 44

What is the 5 year survival rate of ovarian cancer?

Answer 44

45% - survival dependent on stage at diagnosis

Question 45

What increases the survival rate of ovarian cancer?

Answer 45

Detecting prior to spreading outside of the ovary