Ovaries

Question 1

Are ovarian cysts common / rare?

Answer 1

V common

Question 2

Presentations of benign ovarian tumours ?

Answer 2

A symptomatic
Chronic pain - dull ache, dyspareunia, cyclical pain
Acute pain - bleeding into cyst, ovarian torsion, rupture
Irregular vaginal bleeding
Abdo swelling/ mass

Question 3

Vaginal exam of benign ovarian tumour?

Answer 3

Discharge
Bleeding
Mass
Tenderness

Question 4

Abdo exam of benign ovarian tumour ?

Answer 4

Mass raising from pelvis
Tenderness
Peritonism
Ascites

Question 5

If tumour is small, could examination for benign ovarian tumour be normal?

Answer 5

Yes

Question 6

Investigations for benign ovarian tumour?

Answer 6

FBC
CA125 if >40 years
AFP, CA19-9, LDH, hCG, CEA if <40 yrs old
TVS
Transabdominal US if cysts extends outside pelvis
MRI if cyst >7cm

Question 7

Management of benign ovarian tumour if pre -menopausal?

Answer 7

Rescan in 6 weeks
If no malignancy and asymptomatic then no surgery needed.
If >5 cm or symptomatic - laparoscopic ovarian cystectomy

Question 8

Management of a benign ovarian tumour if post menopausal ?

Answer 8

Low risk <5cm - repeat TVS and CA125 every 4 months.
Moderate risk - bilateral oophrectomy
High risk - referral for staging laparotomy

Question 9

What is a functional cyst?

Answer 9

Enlarged or persistent follicular/ corpus luteum cyst.
Very common
May cause pain

Question 10

Treatment for functional cysts?

Answer 10

Usually resolve over few months

Question 11

What are endometriomas?

Answer 11

Ovarian cysts filled with old blood.

Chocolate cysts

Question 12

What is a fibroma?

Answer 12

Small, solid, benign, fibrous tissue tumours

Question 13

What do sex- cord tumours arise from?

Answer 13

Cortical mesenchyme

Question 14

What is a teratoma?

Answer 14

Arises from primitive germ cells.

More common in young women

Question 15

Risk factors for ovarian cancer?

Answer 15

Nulliparity
Early menarche/ late menopause
BRCA 1 &2

Question 16

What are protective for ovarian cancer?

Answer 16

Pregnancy
Breast feeding
COCP

Question 17

Presentation of ovarian cancer?

Answer 17

Bloating
Weight loss
Loss of appetite
Early satiety 
Fatigue
Urinary symptoms / change in bowel habit 
Abdo/pelvic pain
Vaginal bleeding 
Pelvic mass

Question 18

Potential findings on Examination for ovarian cancer?

Answer 18

Fixed abdo/ pelvic mass
Ascites
Omental mass
Pleural effusion
Supraclavicular lymph node enlargement

Question 19

Investigations for ovarian cancer?

Answer 19

FBC, U&Es, LFTs
Maybe CA125 increase
TVS
CXR 
CT abdo/pelvis
MRI
If Ascites/ pleural effusion -> cytology

Question 20

Stage I ovarian cancer?

Answer 20

Confined to ovary
Ia - one ovary
Ib - both ovaries

Question 21

Stage II ovarian cancer?

Answer 21

Limited to pelvis

Question 22

Stage III ovarian cancer?

Answer 22

Limited to abdomen - including regional lymph node mets

Question 23

Stage IV ovarian cancer?

Answer 23

Metastasis around body

Question 24

Treatment for ovarian cancer ?

Answer 24

Full staging laparotomy
If stage III/IV- neoadjuvant chemo
Chemo after surgery on less stage I

Question 25

What chemo is given in ovarian cancer?

Answer 25

Carboplatin with paclitaxel

Question 26

Different ovarian cancers?

Answer 26

Epithelial ovarian tumours Germ cell tumours Stromal /sex cord tumours

Question 27

Types of stromal/ sex cord tumours?

Answer 27

Granulosa - theca tumours | Sertoli-leydig cell tumours

Question 28

Types of germ cell tumours?

Answer 28

``` Teratoma Dermoid cyst Immature teratoma Dysgerminoma Yolk sac tumour Choriocarcinoma Mixed germ cell tumour ```

Question 29

Types of epithelial ovarian tumours?

Answer 29

``` Serous Mucinous Endometrioid Clear cell Brender ```

Question 30

Classifications of serous ovarian tumours?

Answer 30

High grade STIC Low grade STIC (STIC - serous tubal intraepithelial carcinoma)