Ovarian Masses

Question 1

What is a functional cyst?

Answer 1

This is a benign feature of the ovary that is related to ovulation - forms a cyst

Question 2

Describe the types of functional cysts?

Answer 2

Follicular = from the follicle containing an oocyte
Luteal = from the corpus luteum

Question 3

How are functional cysts treated?

Answer 3

will usually resolve themselves

Question 4

How do functional cysts present?

Answer 4

asymptomatic, often an incidental finding

may have menstrual bleeding irregularities

Question 5

What is an endometriotic cyst?

Answer 5

this is a cyst formed from endometrial tissue that is existing outwith the uterus (endometriosis)

Question 6

What is the description of an endometriotic cyst?

Answer 6

Chocolate cysts

Question 7

How can endometriotic cysts present?

Answer 7

severe pain peri-menstrual and during menstruation (dysmenorrhoea), associated with dysparenuia, subfertility, tender mass

Question 8

How will endometriotic cysts feel on palpation?

Answer 8

tender mass with nodular quality

Question 9

Can endometriotic cysts be asymptomatic?

Answer 9

yes can be large and then rupture - AHH

Question 10

Name the tumours of the surface epithelium of the ovary.

Answer 10

CB with this MES
C = clear cell
B = Branners
M = mucinous
E = endometroid
S = serous

Question 11

Name the tumour of the germ cell

Answer 11

Teratomas (malignant cancers of this type are v v rare)

Question 12

Name the tumours of the stroma

Answer 12

Thecal = produce androgens, hirsuitism, virilisation
Granulosa = produce oestrogen, precocious puberty or PMB
Fibroma too

Question 13

If mets are on the ovary where is the likely primary source?

Answer 13

breast, pancreas, stomach, GI

Question 14

How will ovarian cancer likely present?

Answer 14

Mass, swelling, pressure, bloating, urinary symptoms, blood in stool, heartburn, early satiety, weight loss, SOB, leg oedema, DVT - very broad spectrum of presentation

Question 15

Will ovarian cancer spread early?

Answer 15

Yes - to the omental, peritoneal surfaces

Question 16

Is there a genetic component to ovarian cancer?

Answer 16

only 5% have a FHx but it has been associated with BRCA1 and BRCA2 genes, also lynch syndrome (HNPCC)

Question 17

What are some risk factors for ovarian cancer?

Answer 17

older age, nulliparous, FHx

Question 18

What is protective against ovarian cancer?

Answer 18

OCP

Question 19

What investigations would you carry out in suspected ovarian cancer?

Answer 19

CA-125 and CEA markers
USS for tumour nature
CT for assessment of mets

Question 20

Describe CA-125 tumour marker?

Answer 20

This is raised in 80% of ovarian tumours but is not specific (it can be raised in pancreatitis, pregnancy, peritonitis etc)

Question 21

Describe CEA tumour marker

Answer 21

may be moderately raised in ovarian cancer but it mainly to exclude GI mets (primary)

Question 22

What would an USS show?

Answer 22

both solid and cystic qualities, multi-loculated, thickened separations, associated with ascites and there may be bilateral disease

Question 23

What is a CT used for?

Answer 23

staging the disease and investigating mets

Question 24

How is the risk of malignancy calculated?

Answer 24

menopausal status x CA-125 x USS score

Question 25

How is suspected ovarian malignancy managed?

Answer 25

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

Question 26

What does TAH-BSO stand for?

Answer 26

Total abdominal hysterectomy and bilateral salipingo-oophorectomy

Question 27

Does chemotherapy play a role in treatment

Answer 27

Yes - chemo can be used before and after surgery

Question 28

Is ovarian cancer curable?

Answer 28

unlikely as it spreads early and presents late, screening has not proven useful.

Question 29

When would you suspect mets instead of primary ovarian cancer?

Answer 29

if bilateral and small tumour

Question 30

How many ovarian tumours are epithelial cell in origin?

Answer 30

70%

Question 31

How many ovarian tumours are germ cell in origin?

Answer 31

15-20%

Question 32

Another name for follicular cysts are?

Answer 32

Functional cysts but these are the type of cyst present in polycystic ovaries.

Question 33

What is an ectopic pregnancy?

Answer 33

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

Question 34

When should you suspect ectopic pregnancy?

Answer 34

Amenorrhoea, positive UPT, empty uterus. | may present acutely with acute abdomen and hypotension due to rupture