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Gen Med: Ob/gyn > Ovarian/Uterine Disorders > Flashcards

Ovarian/Uterine Disorders Flashcards

1
Q

Define ovarian cysts. What are the different types?

A
  1. Benign fluid filled sac within or on the ovary
  2. Benign functional cysts
    A. Most common: follicular & corpus luteum cysts
  3. Most
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2
Q

What are the types of functional cysts?

A
  1. Follicular cyst
  2. Corpus luteum cysts
  3. Theca lutein cysts
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3
Q

What are the types of nonfunctional cysts?

A
  1. Polycystic ovary syndrome
  2. Chocolate cysts
    A. Caused byendometriosis
  3. Hemorrhagic cyst
  4. Dermoid cyst
  5. Ovarian serous cystadenoma
  6. Ovarianmucinous cystadenoma
  7. Paraovarian cyst
  8. Cystic adenofibroma
  9. Borderline tumoral cysts
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4
Q

What are the sxs of ovarian cysts?

A
  1. Most asymptomatic
  2. Sometimes irregular menses
  3. Pelvic pain/dyspareunia
  4. Abd bloating
  5. LBP
  6. Adnexal tenderness
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5
Q

How are ovarian cysts diagnosed?

A
  1. Urine HCG
  2. Pelvic USN
    A. Trans-abdominal
    B. Trans-vaginal
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6
Q

What are the complications from ovarian cysts?

A 
1. Cyst Rupture
A. Self-limiting
B. Requires observation &pain medications
2. Ovarian torsion
A.Cyst > 4cm ↑ risk
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7
Q

What is the prognosis for ovarian cysts?

A
  1. About 95% of ovarian cysts arebenign
  2. Functional cysts & hemorrhagic ovarian cysts usually resolve spontaneously
  3. The bigger the cyst, the less likely it is to resolve on its own
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8
Q

When may treatment be required for ovarian cysts?

A

Tx may be required if cysts persist over several months, grow or cause ↑ pain

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9
Q

When should ovarian cysts be investigated with laparoscopy?

A
  1. Cysts > 3 menstrual cycles
  2. post-menopausalwomen
  3. Large cysts (> 5 cm) or compound cysts
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10
Q

What is important to know about ovarian cysts in post menopausal women?

A

Cysts in post menopausal women are considered malignant until proven otherwise

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11
Q

How are cysts managed in pre-menopausal women?

A
  1. Follow for 1-2 cycles in premenopausal women

2. F/U USN for women of reproductive age w/ small simple or hemorrhagic cyst is generally not required

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12
Q

What is the treatment for cysts?

A
  1. OCP for prevention
  2. NSAID’s prn
  3. Cyst drainage or removal
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13
Q

What is the most common ovarian cancer?

A

Most common histologic type - epithelial ovarian tumor

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14
Q

What are the general characteristics for ovarian cancer?

A
  1. Malignant transformation of ovarian cells
  2. 2nd most common GYN cancer
  3. Oral contraceptives are protective
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15
Q

Where does ovarian cancer spread to?

A
  1. Ovarian tumors spread rapidly intraperitoneally via local tissue extension, lymphatics & blood
  2. Extraperitoneal spread travels through diaphragm into chest cavity and may cause pleural effusions
  3. Other mets are rare
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16
Q

True/false: ovarian cancer is easy to diagnose

A

False: ovarian cancer is difficult to diagnose until it has spread via the lymph system or by direct extension to other organs or tissues

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17
Q

What are the rf for ovarian cancer?

A
  1. Older women
  2. Nulliparity
  3. Delayed childbearing
  4. Early menarche
  5. Late menopause
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18
Q

What are the sxs for ovarian cancer?

A
  1. Diagnosis often delayed because of lack of specific sx’s
  2. Possible sx’s:
    A. Vague abd pain, ascites, abdominal distention, vague GI sx’s
  3. Most pts 40 - 60 years
  4. May have adnexal mass: solid, irregular, fixed
    A. Diffuse nodularity on pelvic & rectovaginal exam
  5. Abdominal tenderness
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19
Q

What are the dx studies for ovarian cancer?

A
  1. Pelvic USN
    A. Suggests cancer: solid component, size > 6cm, irregular shape
  2. CT chest/abd/pelvis before surgery evaluate extension/metastasis
  3. 5-10% of pts have BRCA mutation (pts with BRCA1 have 20-40% lifetime risk)
  4. CA-125 is a marker used to follow treatment, esp in postmenopausal women
    A. Mildly ↑ in endometriosis, pregnancy, PID, fibroids, peritoneal inflammation, peritoneal cancers
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20
Q

What is the treatment for stage I ovarian cancer?

A
  1. Surgery (Stage I, grade 1)

2. Surgery and chemotherapy (Stage I, grade 3)

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21
Q

What is the treatment for stage II ovarian cancer?

A
  1. Surgery

2. Surgery and adjuvant chemotherapy

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22
Q

What is the treatment for stage III and IV ovarian cancer?

A
  1. Surgery and adjuvant chemotherapy (either intravenous or a combination of IV and IP)
  2. Neoadjuvant chemotherapy followed by interval surgery\
  3. Chemotherapy only (if surgery is not possible)
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23
Q

How is ovarian cancer screened for?

A
  1. Screening w/ pelvic USN & CA125 can detect some early ovarian CA-no evidence it improves outcome
    A. Recommended for certain high risk individuals
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24
Q

What is the general medical treatment for ovarian cancer?

A
  1. GYN Oncology referral
  2. Chemotherapy & radiation therapy after surgery & w/recurrence
  3. Neoadjuvant chemoTx - ↓ size of the tumor before surgery
  4. Adjuvant chemoTx - destroys cancer remaining after surgery
25
Q

What is the general surgical treatment for ovarian cancer?

A
  1. Laparoscopic staging in very early cancer
  2. Laparotomy
    A. TAH/BSO vs salpingo-oophorectomy vs debulking surgery
    B. Evaluate & may Bx all peritoneal surfaces, diaphragm, abdominal & pelvic organs
    C. Washings from pelvis, abdominal gutters, diaphragmatic recesses
    D. +/- omental resection
    E. Sample pelvic & para-aortic nodes
26
Q

What is the prognosis for ovarian cancer?

A

Prognosis based on stages I-IV, recurrence high in stages III & IV

27
Q

When is prophylactic BSO recommended for a pt with ovarian cancer?

A

Consideration of prophylactic BSO after childbearing complete if (+) BRCA1 or 2 mutation

28
Q

When is intraperitoneal chemotx recommended?

A

The National Cancer Institute has recommended for stage III disease after a successful surgical debulking procedure

29
Q

What are the survival rates for ovarian ca?

A 
1. At 1-yr / 5-yr
A. Stage I  96-100%  /   83-90%
B. Stage II 93-94%   /    65-71%
C. Stage III 85-88%  /    33-47%
D. Stage IV 72%      /     19%
30
Q

Define leiomyoma/fibroid tumor

A

Benign tumors that arise from the overgrowth of smooth muscle & connective tissue in the uterus

31
Q

What is the etiology of leimyoma?

A

Genetic predisposition

32
Q

What may leiomyomas lead to?

A
  1. May lead to menorrhagia (DUB), often causinganemia
  2. May contribute toinfertility
  3. About 1 out of 1000 lesionsbecome malignant
33
Q

What are the sxs of leimyomas?

A
  1. Asymptomatic
  2. DUB: dysfunctional uterine bleeding
  3. LBP: low back pain
  4. Dysmenorrhea
  5. Dyspareunia
  6. Urinary frequency
  7. Infertility (rare)
34
Q

What are the rf of leimyomas?

A
  1. African descent
  2. Obesity
  3. PCOS
  4. DM
  5. HTN
  6. Nulliparous
  7. 20% to 80% of women develop fibroids by the age of 50
35
Q

How are leiomyomas dxed?

A
  1. Pelvic exam

2. USN

36
Q

What are the types of fibroids?

A
  1. Intramural fibroids - located w/in wall of the uterus, most common
  2. Subserosal fibroids - located underneath the mucosal (peritoneal) surface of uterus & can become very large
  3. Submucosal fibroids - located in muscle beneath endometrium & distort the uterine cavity
    A. May lead to bleeding &infertility
  4. Cervical fibroids are located in the wall of the cervix
37
Q

What can dysfunctional uterine bleeding lead to?

A

Anemia

38
Q

What can the pressure from leiomyomas lead to?

A

Due to pressure on GI tract → constipation& bloating

39
Q

Why may a pt with a leiomyomas have hydronephrosis?

A

Compression of ureter

40
Q

When can leiomyomas become malignant?

A
  1. In very rare cases, malignant leiomyosarcoma of the myometrium can develop
  2. In extremely rare cases uterine fibroids may present as part or early sx ofhereditary leiomyomatosis & renal cell cancersyndrome
41
Q

How are asymptomatic leiomyomas treated?

A

No Tx unless symptomatic

42
Q

How are symptomatic leiomyomas treated?

A
  1. NSAIDs to control symptoms
  2. Iron supplement for anemia
  3. OCP or Progesterone to control DUB
    A. Mirena/Skyla/Provera
  4. Ultrasound fibroid destruction
  5. Myomectomy or radio frequency ablation
  6. Hysterectomy
  7. Uterine artery embolization
    A.Interventional radiologist occludes both uterine arteries
43
Q

What is the most common gyn cancer in developed countries?

A

Endometrial cancer

44
Q

What is the TAH procedure?

A

Total abdominal hysterectomy

45
Q

What is the BSO procedure?

A

bilateral salpingo-oophorectomy

46
Q

What are the general characteristics of endometrial cancer?

A
  1. Typically present w/DUB
  2. In US, 80% of endometrial cancers are adenocarcinoma
  3. American women - 2.6 % lifetime risk of developing uterine CA
  4. Avg age = 61 years
47
Q

How does endometrial cancer spread?

A
  1. Direct extension
  2. Lymph mets (upper abd mets common)
  3. Peritoneal mets after transtubal spread
  4. Hematogenous spread (mets to lungs uncommon)
48
Q

What is included in the pe for suspected endometrial cancer?

A
  1. Pelvic & bimanual exam is usually unremarkable (in early stage)
  2. In postmenopausal women, if Pap smear reveals endometrial cells, need to think of endometrial CA
49
Q

What dx studies are used for endometrial cancer?

A
  1. Pelvic USN
  2. PAP smear
  3. Endometrial Bx
50
Q

What are the general characteristics for endometrial biopsy?

A
  1. Office procedure

2. Accuracy of detecting cancer is 91-95%

51
Q

What is the management for symptomatic pts with a negative endometrial biopsy?

A

D and C

52
Q

What is the definitive procedure for dx of endometrial cancer?

A

Dilation and curettage (D and C)

53
Q

How is endometrial cancer staged?

A
  1. Surgery & staging w/ pelvic & periaortic nodes
    A. TAH-BSO & pelvic node dissection
    B. High cure rate if detected early
54
Q

How is advanced endometrial cancer treated?

A
  1. If advanced disease or not a surgical candidate, primary radiation therapy is treatment
55
Q

When is chemotherapy used for endometrial cancer?

A
  1. Infrequent use of chemoTx

2. Used mostly w/ mets

56
Q

When is high dose progesterone therapy used for endometrial cancer?

A

High-dose progesterone therapy for grade I endometrial CA has 75% response rate

57
Q

How can endometrial cancer be prevented?

A
  1. Weight control
  2. Physical exercise
  3. Control of DM & HTN
  4. ↑ surveillance of women at high risk
58
Q

What is the prognosis for endometrial cancer?

A 
1. Overall 5-yr survival rates:
A. Stage I    81-95%
B. Stage II   67-77%
C. Stage III  31-60%17%  
D. Stage IV  5-20%
  1. TAH-BSO should result in >95% at 5 years

Gen Med: Ob/gyn (13 decks)

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