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Yr 2 - EMS > Ovarian Tumours > Flashcards

Ovarian Tumours Flashcards

1
Q

What are the 3 classifications of ovarian tumours?

A

Benign, borderline or malignant

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2
Q

Where can ovarian tumours arise from?

A
  1. Sex-cord stroma 2. Germ cell tumours 3. Surface epithelial tumours
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3
Q

What is the outside of the ovary lined by?

A

A lining of simple cuboidal-to-columnar shaped mesothelium, called the germinal epithelium.

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4
Q

What is stroma?

A

The supportive tissue of an epithelial organ, tumour, gonad, etc., consisting of connective tissues and blood vessels

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5
Q

What kind of change does the mesothelium lining the ovary have the ability to undergo? What tumours can this lead to?

A

Metaplasia –> into epithelia from any part of the female genital tract Can lead to surface epithelial tumours

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6
Q

What are the most common types of surface epithelial tumours?

A
  • Serous (tubal mucosa) - Mucinous (endocervical) - Endometrioid (endometrium)
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7
Q

Where do sex-cord stroma tumours arise from?

A

Sex cord stroma

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8
Q

Where do germ cell tumours arise from?

A

From the oocyte

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9
Q

Clinical Case:

Rachel, a 75 year old female, who is normally fit and well. She has a BMI of 35. She has attended the GP with a 2 month history of:

  • Increased abdominal distension and bloating
  • Non-specific lower abdominal pain, intermittent
  • Fatigue, decreased appetite
  • No change in bowel habit

Differential diagnoses?

A
  • Malignancy?
    • Ovarian
    • Other gynaecological malignancy
    • Bowel
  • Metastases
  • Uterine abnormality – fibroid
  • Other causes of ascites i.e. liver cirrhosis
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10
Q

What investigations would be offered to Rachel?

A
  • Refer urgently to gynaecology
  • Base line bloods including LFTs
  • Serum CA125
    • Can be used as tumour marker in Ovarian cancer
  • Pelvic and abdominal ultrasound
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11
Q

What is serum CA125?

A

A CA 125 test measures the amount of the protein CA 125 (cancer antigen 125) in your blood –> can be used as tumour marker in Ovarian cancer

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12
Q

Results for Rachel:

  • Ca125 – significantly elevated
  • Ultrasound:
    • Gross ascites
    • Bilateral adnexal masses
    • Made up of cysts with solid areas
    • Masses show vascularity

“highly suspicious for ovarian malignancy”

She is then urgently referred for CT pelvis and abdomen where ovarian malignancy and possible peritoneal lesions are found.

What are the differential diagnoses?

A
  • Malignant ovarian neoplasm
    • Epithelial tumour
    • Germ cell tumour
    • Sex-cord stromal tumour
  • Other gynaecological malignancy
  • Metastases
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13
Q

What % of ovarian tumours arise from the surface epithelium of the ovary?

A

Around 90%

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14
Q

What are the 3 classifications of ovarian epithelial tumours?

A
  • Benign
  • Borderline
  • Malignant
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15
Q

What characterises a ‘borderline’ epithelial tumour?

A

Abnormal architecture but no evidence of invasion

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16
Q

What defines a ‘malignant’ ovarian epithelial tumour?

A

Evidence of invasion

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17
Q

What type of epithelial lining lines the fallopian tube?

A

Serous epithelium

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18
Q

What type of epithelial lining lines the endocervix?

A

Mucinous epithelium

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19
Q

What type of epithelial lining lines the endometrium?

A

Endometroid

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20
Q

Is serous, mucinous and endometroid epithelium glandular or not?

A

All glandular types of epithelium

i.e. all epithelial tumours are glandular

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21
Q

What suffix is used in benign ovarian epithelial tumours?

A

-oma

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22
Q

What suffix is used to descibe tumours of glandular epithelium?

A

-adeno

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23
Q

How can benign ovarian epithelial tumours then be subclassified?

A

Based on components:

  • Composed of cysts
  • Fibrous tissue
  • Cystic and fibrous
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24
Q

What is the name for a benign ovarian epithelial tumour composed of cysts?

A

Cystadenoma

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25
Q

What is the name for a benign ovarian epithelial tumour composed of fibrous tissue?

A

Adenofibroma

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26
Q

What is the name for a benign ovarian epithelial tumour composed of cystic and fibrous?

A

Cystadenofibroma

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27
Q

Ovarian mucinous cystadenoma

A
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28
Q

What suffix is used to describe malignant epithelial tumours?

A

-carcinoma

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29
Q

What is the name for a malignant ovarian epithelial tumours?

A

Cystadenocarcinoma

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30
Q

How are cystadenocarcinomas then further classified?

A

By type of epithelium e.g. serous cystadenocarcinoma

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31
Q

How can malignant ovarian tumours be graded?

A
  • High grade (aggressive)
  • Low grade (slower growing, less aggressive, better prognosis)
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32
Q

Serous cystadenocarcinoma under microscope

A
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33
Q

What does ovarian tumour staging determine?

A
  • How far the cancer has spread from the ovary
  • Determines her future treatment
34
Q

Benign vs malignant under microscope

A
35
Q

How is ovarian cancer staged?

A

FIGO staging

36
Q

what is the FIGO staging system?

A
  • stage 0: carcinoma in situ (common in cervical, vaginal, and vulval cancer
  • stage I: confined to the organ of origin
  • stage II: invasion of surrounding organs or tissue
  • stage III: spread to distant nodes or tissue within the pelvis
  • stage IV: distant metastasis(es)
37
Q

What is routinely tested as a tumour marker?

A

Ca125

38
Q

Non-specific symptoms of ovarian cancer?

A
  • weight loss
  • bloating, fatigue
  • urinary frequency
  • sometimes PV bleeding
39
Q

Define epidiemiology

A

the branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health.

40
Q

Define aeitology

A

the cause, set of causes, or manner of causation of a disease or condition.

41
Q

Risk factors for epithelial ovarian cancer?

A
  • Age (increasing)
  • Genetic susceptibility
    • 5-15% of ovarian cancer caused by BRCA1/2
    • -3x increased risk in females with mother or sister with Ovarian Cancer
  • Smoking
  • HRT
  • Obesity
42
Q

Protective factors against ovarian cancer?

A
  • Having children
  • Breastfeeding
  • COCP (combined oral contraceptive pill)
43
Q

Clinical Case 2 –> Laura: 30 year old female

  • Dull ache in lower abdomen for 3/52
  • Irregular periods
  • Bloating
  • No urinary symptoms
  • No systemic symptoms
  • Normally fit and well

Differential diagnoses?

A
  • Ectopic pregnancy —> do this FIRST
  • Ovarian neoplasm
    • Epithelial / germ cell / sex-cord stromal
    • Benign / malignant
  • Other gynaecological causes – functional cyst, ovarian torsion, pelvic inflammatory disease, PCOS, fibroid
  • GI tract causes
44
Q

Investigations for Laura?

A
  • Pregnancy test - negative
  • Urine sample – normal
  • Transvaginal pelvic ultrasound:
    • Unilateral cystic left ovarian mass measuring approximately 7cm
    • Some calcified components
    • No vascularity within mass
    • No ascites noted
  • Blood tests for LDH, α-FP and βHCG performed - normal
45
Q

Treatment for Laura? (and results)

A

Patient has a laparoscopy to remove the cyst and ovary

46
Q

Cystic structure for Laura contains:

  • Hair
  • Sebaceous material
  • Teeth

What is it

A

Mature cystic teratoma

47
Q

What types of germ cell tumours are there?

A
  • Teratomas (most common)
  • Yolk sac tumours
  • Embryonal carcinoma
  • Dysgerminomas
48
Q

What is the most common germ cell tumour?

A

Teratomas

49
Q

What % of all ovarian neoplasms do teratomas make up?

A

Around 20% of all ovarian neoplasms

50
Q

Are teratomas benign or malignant?

A
  • Nearly all are benign (mature cystic teratoma)
    • 1% show malignant transformation (immature teratoma)
51
Q

Who do teratomas generally occur in?

A

Young women

52
Q

Where do teratomas arise from?

A

Arises from oocyte that has completed first meiotic division

53
Q

What is a ‘mature cystic teratoma’ defined as?

A

“Tumour that contains elements of all three germ cell layers”

  • Ectoderm –> e.g. skin and hair
  • Mesoderm –> e.g. muscle, bone, cartilage
  • Endoderm –> e.g. respiratory epithelium, GI epithelium
54
Q

What is a dysgerminoma? Are they common? What is used as a tumour marker?

A
  • Malignant germ cell tumour of the ovary
  • Very rare
  • LDH used as tumour marker
  • Sensitive to chemo
55
Q

What is LDH?

A

Lactate dehydrogenase –> found to be increased in cancer patients

56
Q

What is a yolk sac tumour? Is it malignant? What is used as a tumour marker?

A
  • Malignant germ cell tumour of the ovary
  • Sensitive to chemo
  • a-FP used as tumour marker
57
Q

What is a choriocarcinoma? Is it malignant? What is used as a tumour marker?

A
  • Malignant germ cell tumour of the ovary
  • Extremely rare
  • Differentiation towards placenta
  • Produces βHCG –> tumour marker
58
Q

Where do sex-cord stromal tumours arise from?

A

Arise from ovarian stroma that was derived from the sex cord of the embryonic gonad

59
Q

What do sex cord stromal tumours frequently produce?

A

Steroid hormones

60
Q

What are the 3 types of sex cord stromal tumours?

A
  1. Thecoma / fibrothecoma / fibroma
  2. Granulosa cell tumours
  3. Sertoli-Leydig cell tumours
61
Q

Are thecomas / fibrothecomas / fibromas benign or malignant?

A

Benign

62
Q

What hormones do thecomas and fibrothecomas produce?

A

Oestradiol

63
Q

Who do thecomas / fibrothecomas / fibromas most commonly present in?

A

Older women (post menopausal) –> may present with abnormal uterine bleeding due to oestradiol

64
Q

What is Meig’s syndrome?

A

The triad of:

  1. benign ovarian tumour (mostly fibromas)
  2. ascites
  3. pleural effusion
65
Q

Are granulosa cell tumours benign or malignant?

A

Low grade malignant

66
Q

What hormones do granulosa cell tumours produce?

A

Oestradiol

67
Q

Are Sertoli-Leydig cell tumours benign or malignant?

A

10-25% malignant

68
Q

What hormones do Sertoli-Leydig cell tumours produce? What symptoms does this lead to?

A

Testosterone –> increase in this causes anovulation, acne, hirsutism

69
Q

What is anovulation?

A

Anovulation is when the ovaries do not release an oocyte during a menstrual cycle

70
Q

What is hirsutism?

A

Hirsutism is where women have thick, dark hair on their face, neck, chest, tummy, lower back, buttocks or thighs

71
Q

How are metastatic ovarian tumours spread?

A
  • Direct spread
  • Or by lymphatic/haematogenous spread
72
Q

Where do metastatic ovarian tumours most commonly originate from?

A
  • Colon
  • Stomach (Krukenberg tumour)
  • Breast
73
Q

What is the most effective way of evaluating an ovarian mass?

A

Pelvic ultrasound

74
Q

What serum markers are tested for in ovarian neoplasms?

A
  • Ca125 – appropriate in cases with complex cysts
  • α-FP, LDH, ΒHCG in cases of suspected germ cell tumour
75
Q

What investigation is used for suspected malignancies or complex lesions?

A

CT/MRI

76
Q

How is the final diagnosis of an ovarian neoplasm determined?

A

By pathology of specimen

77
Q

What is the most common type of ovarian cancer?

A

Epithelial

78
Q

Is a cystaenofibroma a malignant lesion?

A

No (-oma)

79
Q

In a suspected germ cell tumour, which tumour markers would be performed?

A

AFP, LDH, BHCG

80
Q

What is a krukenberg tumour an example of?

A

Metastatic tumour (typically comes from stomach)

Yr 2 - EMS (60 decks)

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