Ovarian tumours Flashcards
What is the incidence of malignant vs benign ovarian tumours?
Benign-75%
Malignant-25%
At what age do malignant ovarian tumours peak?
45-65 years
At what age do malignant ovarian tumours peak?
Between 20-45 years
What are the 3 types of functional cytsts?
- Follicle cyst
- The a lutein cyst
- Corpus lutein cyst
Describe follicular cysts?
- They are caused by increased gonadotropin stimulation due to failure to ovulate
They are clear fluid filled cysts with smooth surfaces and can be asymptomatic or have pain or menstrual irregularity
They usually regress spontaneously
What are the a lutein cysts?
These are also caused by increased gonadotropin stimulation
- multicystic, yellow fluid and often are bilateral
- they may be complicated by: torsion, ovarian rupture or intra-ovarian haemorrhage
What is hyperreactio luteinalis?
When both ovaries form soft grape like, multi-cystic enlargements of up to 25cm
What is the ovarian hyper stimulation synrome?
It is the induction of ovulation using menopausal or pituatary gonadotropins
The patients become severely shocked with massive fluid shifts into the peritoneal and pleural cavity
What is a corpus luteum cyst?
It is a cyst that appears after the formation of the normal corpus luteum and persists as blood filled and regresses spontaneously just before the next menstruation
Usually 2cm in diameter and about 7-8 cm
How do we diagnose a corpus literal cyst?
With hCG and laparoscopy when in doubt
What are the ultrasound features we would be looking for in an ovarian cyst?
- Thin cyst walls
- Smooth walls
- Unlilocularity (one cyst)
- Unilaterality
- Clear contents
- Size less than 8cm
- No ascitic fluid present
How can we cause involution of the corpus lute always cysts?
- Monophasic oral contraceptives or medroxy progesterone acetate tablets 5mg per day for 5 days
What do we do with persisting ovarian cysts?
These are cysts that persist for more than 6 weeks
They are no longer functional cysts
-we use surgical exploration like laparoscopy to to remove them
What are the causes of torsion in ovarian tumours?
- Long Fallopian tube
- Weak mesosalpinx
- Interrupted tube after tubal ligation
How does the patient present with a ovarian torsion?
- Low grade fever
- Nausea and vomiting
- Severe abdominal pain
- Vomiting and fainting
What are the non-unctional cysts of the ovary?
- Polycystic ovaries
- Endometriomata
- Para-ovarian cysts
- Residual ovarian syndrome
- Ovarian remnant syndrome
How do polycystic ovarian cysts present or hyperthecosis?
- Hyperthecosis is usually 5-7cm in diameter of solid tumour
Patients have amenorrhea or virilisation
What is endometriomata?
When endometriosis occurs on the ovary
Also known as chocolate cyst(dark and haemolysed blood)
Usually excised using laparoscopy
What are para-ovarian cysts?
Similar to ovarian cysts and originate from the Wolffian duct
-benign with clear liquid content
What is the residual ovary syndrome?
This is when the ovaries are conserved and pain and dysparenuia occur months or years after a hysterectomy
This is solved by laparotomy or excision
What is ovarian remnant syndrome?
It is when the patient experiences pelvic pain usually cyclic after bilateral salpingostomy
-surgical exploration is NB
What are the two tumour like conditions of the ovary?
- Pregnancy luteoma
- unilateral, solid nodules form in pregnancy, surface is soft and brown - Oedema of the ovary
- unilateral, due to blocked lymphatic drainage with possible torsion
What is the risk of patients with BRCA gene in developing ovarian cancer?
60%
What are the 4 categories of ovarian tumours?
- Epithelial
- Stromal
- Germ cell
- Metatastic
What are the sub-classifications of epithelial tumours?
- Benign
- Borderline malignant
- Malignant
What are the risk factors for epithelial cell tumours?
- Talc and asbestos
- Low parity (less children) and increased age( recurrent ovulation)
- Genetic- BRCA 1 and 2
What causes a decreased risk of epithelial tumours?
- Multiparity(more than 5 children)
2, oral contraceptive use >5 years
What are the benign epithelial tumours?
- Inclusion cyst
- Serous cystadenoma
- Mucinous cystadenomas
- Cystadenofibromas
What are the malignant epithelium carcinomas?
- Serous carcinoma
- most common
- between 45-65
- amuses blood stained ascites - Mucinous carcinoma
- multi-lobular that are either unilateral or bilateral - Endometroid carcinoma
- moist common after serous tumours
- associated with endometriosis - Clear cell carcinoma
- rare
- 40-70 years
What are the stromal tumours?
They are derived from the embryonal sex cords, ovarian stroma and mesenchyme
They secrete oestrogen and testosterone
What are the stromal cells grouped into?
- Granulosa
- Thecomas
- Ovarian fibroma
- Leading and serotonin cells
What special investigations do you do in patients with germ cell tumours?
- Alpha-fetoprotein
- B-HCG
- Liver function tests
- Full blood count
- X-rays and pelvic ultrasound
What are the types of germ cell tumours?
- Dysgerminoma
- Teratoma
- Yolk sac tumour
- Choriocarcinoma
- Gonadoblastoma
What are dysgerminomas?
The most common type of
What are dysgerminomas?
The most common type of malignant tumour-occur between 10 and 30 years
- usually a unilateral salpingo-oophorectomy and pelvic washing performed because it is usually young patients
- tendency to be bilateral
- Sensitive to chemotherapy
What is a teratoma?
- Mature
- Usually occur in children and young adults <20 years
- they contain endodermal, mesodermal and ectodermal tissue(hair, bones, sebaceous material, teeth) - Immature
- rare
- the more differentiated it is, the worse the prognosis
What is a yolk sac tumour?
- unilateral growth
- reaches 25 cm
- produces AFP and hCG
What is a choriocarcinoma?
- rare and affects <20 years
- produces hCG and needs surgical resection immediately
- poor prognosis
What is a gonadoblastoma?
Very rare tumour in patients with abnormal gonads
- 46, XY or 45, XO/46, XY mosaicism
- prevention is done by removal of gonads before 25
What are metastatic tumours to the ovary?
About 5% of ovarian carcinomas are metastatic
- majority of ovarian cancers are actually from the breast cancer
-
What are Krukenberg tumours?
These are tumours that account for 30-40% of metastatic cancers to the ovaries usually from the breast, colon and biliary tract
What are the clinical features of ovarian carcinoma in a woman?
- Pelvic mass-mobile,solid, fixed, irregular and if ascites is present
- Abdominal distension, pain ,nausea ,anorexia and constipation
- In pre-menopausal women
- menstrual irregularity, urinary frequency, lower abdominal discomfort
What are the routine special investigations we need to do in patients we suspect with ovarian carcinoma?
- Biochemistry
- FBC,UE, HB, HGT, urine dipstick - X-ray to check for Mets
- Abdominal Ultrasound to look for ascites, and the liver and kidney
- CA125
- CT or MRI if we want to look for liver metastases
How do we stage patients with ovarian carcinomas?
Surgically
