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Gynecology > Ovarian Tumours > Flashcards

Ovarian Tumours Flashcards

1
Q

Tumor marker CA125 increased in:

A

90% of epithelial tumours

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2
Q

Tumour marker HCG increased in:

A

Choriocarcinoma

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3
Q

Alpha-feto protein increased in:

A

Endodermal sinus tumours

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4
Q

carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 increased in:

A

Mucinous tumours

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5
Q

Lactate dehydrogenase increased in:

A

Dysgerminoma

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6
Q

Functional non neoplastic tumors:

A

Follicular cyst : <3cm
Luteal cyst:
1. Corpus luteal cyst: hge into cyst
2. Theca luteal cyst: +HCG, a/w hydatidiform mole, chorioca-clomid or gonadotropine therapy

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7
Q

Pathological non-neoplastic tumors:

A

Ovarian Endometriotic cyst
PCOS

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8
Q

Benign tumors:

A

Epithelial tumors
Benign germ cells tumors
Sex cord stromal tumors

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9
Q

Benign Epithelial tumors

A

Serous cyst adenoma
Mucinous cyst adenoma
Brenner tumor

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10
Q

Benign germ cells

A

Mature teratoma or dermoid cyst

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11
Q

Benign sex cord stromal tumors;

A

Fibroma
Sertoli-leydig cell
Thecoma
Lipoma

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12
Q

Neoplastic tumors:
Surface epithelium

A

Serous cyst adenoma : CA125
Mucinous cyst adenoma: CEA&C19, 9
Clear cell tumor: worst prog, hobnail cells
Endometrioid: a/w EC
Brenner: most are benign

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13
Q

Germ cell tumors embryonic

A
  1. Teratoma: adolsencenc, unilateral symptomless unless ruptured
  2. Dysgerminoma (common form of malignancy in germ cells): phenotypic femal, bilateral, radiosensitive (good prog) ++LDH
  3. Extra embryonic: Endodermal sinus tumor: secrete AFP and non-gestational chorio carcinoma secrete HCG
    4.Gonado plastima
  4. 2ry tumors from metastasis (krukenberg) : bilateral? Signal ring cells
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14
Q

Sex cord tumors(stromal tumors):

A

Granulosa &theca cell tumor
Sertoli-leydig cells (androblastoma or arrhenoblastima)
Gynandroblastoma
Fibroma

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15
Q

It may produces estrogen, cause precocious puberty and postmenopausal bleeding

A

Granulosa & theca cell tumor

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16
Q

It secrets androgen musculining tumour amd causes virilisarion

A

Sertoli-leydig cells

17
Q

It secretes androgen at its sex cord tumor and contains male and female cell type

A

Gynandroblastoma

18
Q

Lobulated bilateral, it causes Meig’s syndrome (ascitis+hydrothorax)it is a non-secreting tumor

A

Fibroma

19
Q

Clinical presentation:

A

Usually asymptomatic unless if rupture or torsion causes pain
Abdominal fullness
Irregular P/V bleeding-loss of weight
urinary symptoms if press bladder
precocious puberty if secreting estrogen

20
Q

On examination :

A

–weight
Respiratory exam (Pleural effusion? Ascitis, mass)

21
Q

PV Bimanual examination

A

Pulge mass> solid or soft regular or iiregular if cystic if fixed or not & if there is nodular suggesting endometriosis

22
Q

D/D

A

Pregnancy
Ascitis
Bladder
Ectopic pregnancy
Hydronephrosis
Pelvic kidney
Fibroid
Tubo ovarian abscess

23
Q

Investigations

A

Tumor markers:
CA125 ++ in 90% of epith. Tumor
CEA, CA19-9 + in mucinous tumor
AFP + in endometrial sinus tumors
LDH> in dysgerminoma

24
Q

Other investigation

A

CBP: U&E , LFT, especially Albumin
USS
Doppler; for tumor that may show ++ vascularity
MRI & CT
IV Pyelography : suspect renal involvement
Barium enema if rectal involvement

25
Q

Treatment of benign:

A

Cystectomy: wish to preserve fertility
Ovarectomy : if large tumor
Hyst.BSO: if her family completed

26
Q

Treatment of malignancy:

A

staging laparatomy through mid line incision:
Hyst
BSO
Omentectomy
Lymph node sampling
Pertoneal biopsies -Scrubbing of diaphram
Pelvic washing or ascitis sampling

27
Q

Treatment of malignancy
If tumor is advanced:

A

Debulking or cytoreductive surgery: The aim is to remove as much tumor as possible

28
Q

Treatment of malignancy
Germ cell tumor confined to single ovary

A

Unilateral slpingeo-oophorectomy & preserve contralateral ovary, and it may need chemotherapy

29
Q

Chemotherapy

A

Ised after surgery

30
Q

Examples of chemotherapy that used in ovarian tumours with S/E

A

Platinum:
Cisplatinum: nephrotoxic, neurotoxicity peripheral neuropathy auto toxicity
Carboplatin: thrombocytopenia &leukopenia
Taxol:
Paclitaxel: hypersensitivity reaction, mucositis-neutropenia-alopecia, BM- depression, arrhythmia and heart attack

Gynecology (20 decks)

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