Ovarian Masses Flashcards
What is a functional cyst?
This is a benign feature of the ovary that is related to ovulation - forms a cyst
Describe the types of functional cysts?
Follicular = from the follicle containing an oocyte Luteal = from the corpus luteum
How are functional cysts treated?
will usually resolve themselves
How do functional cysts present?
asymptomatic, often an incidental finding
may have menstrual bleeding irregularities
What is an endometriotic cyst?
this is a cyst formed from endometrial tissue that is existing outwith the uterus (endometriosis)
What is the description of an endometriotic cyst?
Chocolate cysts
How can endometriotic cysts present?
severe pain peri-menstrual and during menstruation (dysmenorrhoea), associated with dysparenuia, subfertility, tender mass
How will endometriotic cysts feel on palpation?
tender mass with nodular quality
Can endometriotic cysts be asymptomatic?
yes can be large and then rupture - AHH
Name the tumours of the surface epithelium of the ovary.
CB with this MES C = clear cell B = Branners M = mucinous E = endometroid S = serous
Name the tumour of the germ cell
Teratomas (malignant cancers of this type are v v rare)
Name the tumours of the stroma
Thecal = produce androgens, hirsuitism, virilisation
Granulosa = produce oestrogen, precocious puberty or PMB
Fibroma too
If mets are on the ovary where is the likely primary source?
breast, pancreas, stomach, GI
How will ovarian cancer likely present?
Mass, swelling, pressure, bloating, urinary symptoms, blood in stool, heartburn, early satiety, weight loss, SOB, leg oedema, DVT - very broad spectrum of presentation
Will ovarian cancer spread early?
Yes - to the omental, peritoneal surfaces
Is there a genetic component to ovarian cancer?
only 5% have a FHx but it has been associated with BRCA1 and BRCA2 genes, also lynch syndrome (HNPCC)
What are some risk factors for ovarian cancer?
older age, nulliparous, FHx
What is protective against ovarian cancer?
OCP
What investigations would you carry out in suspected ovarian cancer?
CA-125 and CEA markers
USS for tumour nature
CT for assessment of mets
Describe CA-125 tumour marker?
This is raised in 80% of ovarian tumours but is not specific (it can be raised in pancreatitis, pregnancy, peritonitis etc)
Describe CEA tumour marker
may be moderately raised in ovarian cancer but it mainly to exclude GI mets (primary)
What would an USS show?
both solid and cystic qualities, multi-loculated, thickened separations, associated with ascites and there may be bilateral disease
What is a CT used for?
staging the disease and investigating mets
How is the risk of malignancy calculated?
menopausal status x CA-125 x USS score
How is suspected ovarian malignancy managed?
if think benign then remove and drain
if malignant the requires a total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) with debulking of tumour and removal of omentum. There is also examination of the peritoneal surfaces
What does TAH-BSO stand for?
Total abdominal hysterectomy and bilateral salipingo-oophorectomy
Does chemotherapy play a role in treatment
Yes - chemo can be used before and after surgery
Is ovarian cancer curable?
unlikely as it spreads early and presents late, screening has not proven useful.
When would you suspect mets instead of primary ovarian cancer?
if bilateral and small tumour
How many ovarian tumours are epithelial cell in origin?
70%
How many ovarian tumours are germ cell in origin?
15-20%
Another name for follicular cysts are?
Functional cysts but these are the type of cyst present in polycystic ovaries.
What is an ectopic pregnancy?
the implantation of a conceptus anywhere outside the uterine cavitiy - most common location is the fallopian tube but can be in the ovary or peritoneum
When should you suspect ectopic pregnancy?
Amenorrhoea, positive UPT, empty uterus.
may present acutely with acute abdomen and hypotension due to rupture
