Ovaries Flashcards
Are ovarian cysts common / rare?
V common
Presentations of benign ovarian tumours ?
A symptomatic
Chronic pain - dull ache, dyspareunia, cyclical pain
Acute pain - bleeding into cyst, ovarian torsion, rupture
Irregular vaginal bleeding
Abdo swelling/ mass
Vaginal exam of benign ovarian tumour?
Discharge
Bleeding
Mass
Tenderness
Abdo exam of benign ovarian tumour ?
Mass raising from pelvis
Tenderness
Peritonism
Ascites
If tumour is small, could examination for benign ovarian tumour be normal?
Yes
Investigations for benign ovarian tumour?
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
Management of benign ovarian tumour if pre -menopausal?
Rescan in 6 weeks
If no malignancy and asymptomatic then no surgery needed.
If >5 cm or symptomatic - laparoscopic ovarian cystectomy
Management of a benign ovarian tumour if post menopausal ?
Low risk <5cm - repeat TVS and CA125 every 4 months.
Moderate risk - bilateral oophrectomy
High risk - referral for staging laparotomy
What is a functional cyst?
Enlarged or persistent follicular/ corpus luteum cyst.
Very common
May cause pain
Treatment for functional cysts?
Usually resolve over few months
What are endometriomas?
Ovarian cysts filled with old blood.
Chocolate cysts
What is a fibroma?
Small, solid, benign, fibrous tissue tumours
What do sex- cord tumours arise from?
Cortical mesenchyme
What is a teratoma?
Arises from primitive germ cells.
More common in young women
Risk factors for ovarian cancer?
Nulliparity
Early menarche/ late menopause
BRCA 1 &2
What are protective for ovarian cancer?
Pregnancy
Breast feeding
COCP
Presentation of ovarian cancer?
Bloating Weight loss Loss of appetite Early satiety Fatigue Urinary symptoms / change in bowel habit Abdo/pelvic pain Vaginal bleeding Pelvic mass
Potential findings on Examination for ovarian cancer?
Fixed abdo/ pelvic mass Ascites Omental mass Pleural effusion Supraclavicular lymph node enlargement
Investigations for ovarian cancer?
FBC, U&Es, LFTs Maybe CA125 increase TVS CXR CT abdo/pelvis MRI If Ascites/ pleural effusion -> cytology
Stage I ovarian cancer?
Confined to ovary
Ia - one ovary
Ib - both ovaries
Stage II ovarian cancer?
Limited to pelvis
Stage III ovarian cancer?
Limited to abdomen - including regional lymph node mets
Stage IV ovarian cancer?
Metastasis around body
Treatment for ovarian cancer ?
Full staging laparotomy
If stage III/IV- neoadjuvant chemo
Chemo after surgery on less stage I
What chemo is given in ovarian cancer?
Carboplatin with paclitaxel
Different ovarian cancers?
Epithelial ovarian tumours
Germ cell tumours
Stromal /sex cord tumours
Types of stromal/ sex cord tumours?
Granulosa - theca tumours
Sertoli-leydig cell tumours
Types of germ cell tumours?
Teratoma Dermoid cyst Immature teratoma Dysgerminoma Yolk sac tumour Choriocarcinoma Mixed germ cell tumour
Types of epithelial ovarian tumours?
Serous Mucinous Endometrioid Clear cell Brender
Classifications of serous ovarian tumours?
High grade STIC
Low grade STIC
(STIC - serous tubal intraepithelial carcinoma)
