Ovaries Flashcards
Ovarian cysts - Ddx
- Benign ovarian ➤ functional cyst, endometriomas, serous cystadenoma, mucinous cystadenoma, mature teratoma
- Benign non-ovarian ➤ paratubal cyst, hydrosalpinges, tube-ovarian abscess, peritoneal pseudocyst, appendices abscess, diverticula abscess, pelvic kidney
- 1° malignant ovarian ➤ germ cell tumours, epithelial carcinoma, sex-cord tumour
- 2° malignant ovarian ➤ breast CA, GI CA
Endometrioma = chocolate cyst - Infos
- Benign oestrogen dpt cyst - thick old blood
- 2-10 cm
- Precursors for endometrial or clear cell tumours
- Unilateral or bilateral
- Associated with endometriosis
Endometrioma = chocolate cyst - S&S
asymptomatic pelvic P infertility dyspareunia 2° dysmenorrhoea
Endometrioma = chocolate cyst - Tx
OCP
surgery - laparoscopy, ablation, aspiration
M - endometriosis
Nothing ➤ risk of rupture, not recommended if >4cm
Endometrioma = chocolate cyst - Can affect what?
Fertility
Dermoid cyst - types
Mature cystic teratoma + immature teratoma
Mature cystic teratoma - germ layers?
ectoderm, mesoderm, endoderm
Mature cystic teratoma - S&S
asymptomatic
➤ slow growing
Mature cystic teratoma - Cx
torsion
rupture
infection
malignancy
Mature cystic teratoma - Tx
➤ type & size dpt
- watch & wait
- surgery - laparoscopy, laparotomy
- age - menopausal
Mature cystic teratoma - In pregnancy?
Operate >6cm in 2nd trimester
Immature teratoma - infos
- Rare
- Young patient (20 yo++)
- 36% ➤ malignancy
- Often large (14-25 cm) ➤ solid masses
- Increase alpha-feto protein
PCOS - What is it?
Polycystic ovarian syndrome
➤ endocrine disorder ➤ hyperandrogegism ovulatory dysfunction, polycystic ovarian morphology
PCOS - S&S
menstrual disorder - amenorrhea, oligomenorrhoea
infertility
virilisation
acne, hirsutism, androgenic, alopecia
metabolic syndrome - obesity, insulin resistance
PCOS - Dx
PCOM, chronic an ovulation, hyperandrogegism
PCOS - Cx
- Infertility
- Ovarian abnormality ➤ change in vascularity, follicular fluid env, oocyte competence & quality
- Gestational diabetes
- Obstetric Cx ➤ obesity, IR, metabolic dysfunction, placental alterations, inflammation
- Increase pregnancy HT, pre-eclampsia
PCOS - Long-term Cx
- CVS - HT, hyperlipidaemia, DM, increased CRP/TNF-alpha
- metabolic - increase obesity
- IR
- Oncology - increase breast, ovarian, endometrial CA
- Increase depression & anxiety
PCOS - Causes
Unknown ➤ gen + env
PCOS - Tx
Lifestyle - decrease weight
Drugs - clomiphene citrate, oestrogen modulator, aromatose inhibitor, metformin
Surgery - ovarian drilling
Ovarian CA - Who?
> 50 yo ++
Ovarian CA - S&S
persistent abdo distention (bloating) decrease of appetite early satiety pelvic / abdo P increase urinary f. &/or urgency ascites / pelvic or abdo mass
Ovarian CA - Risk factors
nulliparous IUD early ovulation / late menopause HRT fertility Medications & Tx obesity BRCA 1 & 2 PCOS endometriosis env white people talc, alcohol, smoking
Ovarian CA - What decreases risk?
OCP
breast feeding
aspirin
Ovarian CA - Ix
CA125 ➤ if >35 iu/mL ➤ refer US
Gynae referral
Under 40 yo ➤ alpha-feto protein, beta-hCG
Ovarian CA - Staging
T1: limited - 1 or both ovaries, rupture capsule, +ve peritoneum, tutor on ovarian surface
T2: pelvic extension - tubes/uterus/other pelvic organs, +ve cell in peritoneum
T3: extra pelvic extension: microscopic, macroscopic
N1: +ve LN
M1: distant mets
Ovarian CA - Types
Epithelial:
- 90%
- Serous: ++ - 60-70%
- Mucinous: 5%
- Clear cell & endometroid - 15%
- Bordeline - small number, large masses but rarely metastasise
Germ cell
- uncommon
- younger patient
- arise from reproductive cell ovaries
Stromal cell
- arise from supporting tissue
- uncommon
Ovarian CA - Tx
screening surgery chemo radio immuno, H palliative care
Complementary:
- high vits
- herbal & plant extracts
- boost immune
- increase qol
- decrease S&S
Ovarian CA - Pattern of spread
diaphragm liver stomach lung lining implants bowel lining implants omentum LN colon pelvic peritoneal implants
