Ovarian Tumour Flashcards
What is benign ovarian mass?
Non malignant tumor of the ovary:
Epithelial (Brenners tumor, mucinous adenoma, serous adenoma)
Sex-cord stromal tumor (fibroma, thecoma)
Germ call (mature cystic teratoma)
Endmoatrioma
Functional (follicular, luteal, haemorrhagic).
What is the aetiology of benign ovarian mass?
Largely unknown.
Endomatriomas from endometriosis. Funcitonal cyst aorund ovulation.
Cyst accidents caused by rupture, haemorrage into cyst or torsion (rotation on pedicle causing strangulaiton).
Endometriomas are linked to endometriosis.
What is the epidemiology of benign ovarian mass?
4% women cysts prior to 65.
What would you find in the history and exam of a benign ovarian mass?
Lower abdominal pain, deep dyspareunia, pressure symptoms, abdominal swelling, may be asymptomatic.
Acute accident: severe LIF pain, accompanied by vomit if torsion.
Abdomen: iliac fossa tenderness, rebound/guarding if acute
Vaginal: adenxal tenderness, palpable mass
What is the pathology of a benign ovarian mass?
Epithelial
· Serous cystadenoma: most common, thin wall, uniloculated, watery fluid, cuboidal epithelium.
· Mucinous cystadenomaL large, unilatera, multiloculed, thick fluid, mucous secreting columnar cells
· Brenner’s: rare, solid pale yellow, nests of translational epithelium.
Sex cord stromal
· Thecoma: solid yellow, lipid filled cells, oestrogen secreting
· Fibroma: solid white (can give ascites + pleural effusion à Meig’s syndrome)
Mature cystic teratoma (dermoid)
· Germ cells, ectodermal tissue (squamous epith, teeth, hair, sebaceous glands), endodermal tissue (thyroid, intestine) mesodermal tissue (cartilage). 10% bilateral.
Endometrioma
· Retention cysts due to endometriosis.
Funcitonal cysts
· Follicular: unruptures Graafian follicle, lined by granulosa cells.
· Luteal: following rupture, follicle reseals and distends with fluid – lined by luteal cells.
· Haemorragic: bleeding into one of the above functional cysts.
What investigations would you do for benign ovarian mass?
Acute presentation: proceed per acute abdomen, exclude pregnancy.
USS: diagnostic (TVS preferred)
Blood: FBC, GS (prep for theatre) tumor markers (Ca125, HCG, AFP)
What is the management of benign ovarian mass?
Simple small cyst: conservative, repeat scan in 3-6mo.
Suspect torsion or >5cm cyst: ovarian cystectomy (laproscopic or open), oopherectomy if surgical difficulty or necrosis. If suspicious appearance, oopherectomy is recommended esp if postmenopausal.
What are the complications/ prognosis of benign ovarian mass?
Cyst accident, subfertility, malignant change, oopherectomy. Surgery usually cures.
What is an ovarian carcinoma?
Malignant neoplasm of the ovary
What is the aetiology of an ovarian carcinoma?
Unknown. Increased ovulatory cyc,es. Abnormal repair of ovarian surface. BRCA1. Associatd with high age, nullparity, early M/late M, high fat diet, HPNCC.
Protective factors: children, breastfeed, OCP, hysterectomy.
What is the epidemiology of ovarian carcinoma?
Most common gynae malignancy. 1/70 lifetime risk.
What is the history/ exam of ovarian carcinoma?
Late presentation. Abdominal discomfort, distension, fatigue, wt los, pressure symptoms (urinary/GI)
General: signs of malignancy, anaemia, chachexia.
Chest: signs of mets, plural effusion. Abdominal mass, ascites, Hpmegaly. Pelvic mass.
What is the pathology of ovarian carcinoma?
Epithelial: 90%, serous cystadenocarcinoma, mucous cystadenocarcinoma, endometriod carcinoma, clear cell carcinoma.
Germ cell: 5%, dysgerminoma most common.
Sex cord stromal tumors: rarely malignant, most common granulosa cell.
What investigations do you do for ovarian carcinoma?
Bloods: FBC, UE, LFT, clotting, Tumor markers (Ca125, HCG, AFP, CEA, Ca15-3, Ca19-9).
Imaging: TVS USS, high suspicion of solid areas, septae and thickened walls. MRI for surgical plannign if required.
What management do you do for ovarian carcinoma?
· Staging laparotomy: TAH/BSO, peritoneal wash, omentectomy, peritoneal biopst, assessment of lymph nodes.
· Advanced: debulking TAH/BSO, omenectomy, reduce mets.
· Chemotherapy: platinum derivates (cis) and taxanes (palcitaxel).
· Radiotherapy for palliation.
