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Gynae > Ovaries > Flashcards

Ovaries Flashcards

1
Q

Where do the ovaries reside in the anatomy?

A

Ovarian fossa - lateral pelvic wall

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2
Q

How is are the ovaries attached to neighbouring structures?

A
  • To broad ligament via the mesovarium
  • To pelvic side wall by the infundibulopelvic ligament
  • To the uterus by the ovarian ligament
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3
Q

What is the blood supply to the ovaries?

A

Ovarian artery (from aorta)

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4
Q

Describe the two layers of the ovaries:

A

Outer cortex -
- Covered by germinal epithelium (carcinoma most often arises from here)
- Contains follicles with granulosa cells & theca cells
- Granulosa and theca cells secrete oestrogen
Inner Medulla -
- Connective tissue and blood vessels

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5
Q

What stimulates the growth of follicles and what prevents multiple follicles developing at once?

A

FSH (follicle stimulating hormone) causes growth of follicles. These new follicles secrete oestrogen which inhibits FSH

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6
Q

What is the follicle known as after ovulation? What makes the follicle rupture?

A
  • Corpus luteum

- Mid-cycle surge of LH

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7
Q

What maintains the endometrium after ovulation?

A

(E) and (P) secretion from the corpus luteum for 2 weeks

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8
Q

What occurs if fertilisation & implantation happens?

A

Trophoblast of the foetus produced hCG which maintains the curpus luteum for 7-9 weeks (and therefore endometrial maintenance)

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9
Q

What are 3 common symptoms of ovarian pathology?

A
  • Asymptomatic (only discovered on USS)
  • Abdominal distension -> when cyst becomes very large and presses onto other organs.
  • Acute painful presentation - Cyst rupture, haemorrhage into a cyst or peritoneum, torsion of pedicle
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10
Q

What is Polycystic ovarian syndrome?

A

Multiple small cysts= poorly developed follicles

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11
Q

What is PCOS thought to be related to?

A

High levels of insulin. If patient is insulin resistant (i.e. in T2DM) then they will have higher levels of insulin and thus at higher risk of PCOS.

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12
Q

What is PCOS usually more symptomatic?

A

In obese women

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13
Q

Give 3 features of PCOS:

A
  • Oligomenorrhoea (infrequent menstruation)
  • Hirsutism (male-pattern hair growth in females)
  • Sub-fertility
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14
Q

What counts as premature menopause?

A

<40yrs

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15
Q

What Gonadal dysgenesis know as?

A

Turner syndrome (45 X0). Partially or completely missing an X chromosome.

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16
Q

What are the 3 main types of primary ovarian tumours?

A
  • Epithelial tumours
  • Germ cell tumours
  • Sex cord tumours
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17
Q

In what group are epithelial tumours mainly found in?

A

Post menopausal women

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18
Q

Which tumour group are ovarian tumours most commonly found in and what are they typically called?

A

Epithelial -> serous adenocarcinomas. These are the most common ovarian malignancies.

Most are high-grade (70%)

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19
Q

What is cancer can cause the abdominal cavity to fill with gelatinous mucin secretions?

A

Rare. Pseudomyxoma peritonei -> Mucinous adenocarcinoma.

Usually an appendiceal primary tumour

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20
Q

What are the two main types of germ cell tumours?

A

(rare, originate from undifferentiated primordial germ cells)

  • Teratoma/dermoid cyst
  • Dysgerminoma
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21
Q

What are the features of teratoma/dermoids cysts?

A
  • Benign tumour - premenopausal women
  • May contain differentiated tissue of all cell lines
  • Commonly bilateral and asymptomatic -> rupture=painful
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22
Q

What is the most common ovarian malignancy of young women?

A

Dysgerminoma - female equivalent of seminoma

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23
Q

What are the 3 types of sex cord tumours?

A

(rare, originate from the stroma of the gonad)

  • Granulosa cell tumours
  • Thecomas
  • Fibromas
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24
Q

In what group are granulosa cell tumours found?

A

Post menopausal women.

25
Q

What marker is usually monitored during granulosa cell tumours?

A

Inhibin

26
Q

What is inhibin?

A

Inhibin is a protein secreted by granulosa (female) and Sertoli (male) cells in response to FSH, and its major action is the negative feedback control of pituitary FSH secretion.

27
Q

Describe the mechanisms of granulosa cell tumours and 3 features:

A
  • Secrete ^oestrogen and ^inhibin.
  • Malignant
  • Slow growing

3 features:

  • PMB
  • Endometrial malignancy
  • Precocious puberty
28
Q

What benign tumour secretes ^oestrogen and ^androgens?

A

Thecomas (sex cord tumours)

29
Q

What syndrome does ovarian fibroma comprise?

A

Meig’s syndrome:

  • Ascites
  • R pleural effusion
  • Ovarian fibroma
30
Q

What is the Rx for Meigs syndrome?

A

Resolves after resection of mass

31
Q

Where do ovarian mets usually derive from? What percentage of ovarian tumours does this represent? What is the prognosis like?

A
  • Breast + GI
  • 10%
  • Very poor
32
Q

If ovarian mets contain ‘signet ring’ cells - what types of tumour is it?

A

Krukenberg tumour

33
Q

What is a ‘chocolate cyst’?

A

Endometriotic cyst (endometriomas - blood accumulation)

34
Q

What are ovarian ‘functional cysts’? What can cause these?

A

Follicular and lutein cysts (persistently enlarged follicles & Corpora lutea). COCs - stop ovulation so at risk fo developing these cysts.

35
Q

What should be checked if functional cysts are very large?

A

CA 125

36
Q

What is the most common ovarian tumour?

A

Serous adenocarcinoma (95%).

Germ cell tumours (dysgerminomas) if women <35yrs

37
Q

What is the overall 5yr survival rate of ovarian cancer? Why?

A

<50%

Late onset and usually metastatic.

38
Q

What is a protective factor against ovarian cancer?

A

Lack of oestrogen exposure (parity, COC, lactation).

Risk factors: null parity, late menopause, early menarche.

39
Q

What is the inheritance pattern of ovarian cancer?

A
  • 5% familial
  • BRCA1 and BRCA2 -> breast cancer association
  • HNPCC gene mutation -> Lynch syndrome 2
40
Q

What would you do if someone had a +ve FH of ovarian cancer?

A

Test for BRCA1/BRCA2 -> if mutated -> prophylactic salpingo-oophorectomy

41
Q

What percentage of those with ovarian cancer present with stage 3/4 disease?

A

70%

42
Q

Describe 6 possible features of ovarian cancer?

A
  • Persistent bloating/abdominal distention
  • Feeling full/early satiety/decreased appetite
  • Abdominal pain
  • ^ Urinary urgency and frequency
  • IBS-like symptoms (new-onset)
43
Q

What can be found on O/E in those with Ovarian cancer?

A
  • Cachexia (wasting of body due to severe illness)
  • Abdominal/pelvic mass or ascites
  • Palpate the breast for primaries
44
Q

By what means does ovarian cancer usually spread?

A

Direct (transcoelomic spread = spreads across body cavity)

45
Q

Outline the staging of ovarian cancer:

A

Stage 1 - Disease is macroscopically confined to the ovaries

Stage 2 - Disease extending into pelvis (uterus, fallopian tubes)

Stage 3 - Abdominal disease +/- LN involvement

Stage 4 - Disease beyond abdomen (lung or liver parenchyma)

46
Q

If a lady >50 with vague abdominal symptoms presents, what test would you do? If this was abnormal, what further investigations would you do?

A

CA 125

If ^ -> USS abdo + Pelvis and/or pelvic examination.

Urgent referral if +ve

47
Q

What additional markers would be measure in those <40 with abnormal Ix in for suspected ovarian cancer?

A

AFP (alpha-fetoprotein) and hCG measured -> if abnormal suggests germ cell tumour.

48
Q

What does RMI stand for and what are its components?

A

Risk of Malignancy Index = UMCA125

U - ultrasound
M - menopausal status
CA125 - concentration of ovarian tumour marker

49
Q

What level of RMI score requires specialist referral?

A

RMI>250

= CT pelvis/abdo

50
Q

What is the typical management of someone with ovarian cancer?

A

Total hysterectomy + BSO + partial omentectomy.

(depending on spread, may require: bowel resection, splenectomy, peritoneal stripping, LN removal).

Chemotherapy usually follows (if stage above 1c)

51
Q

How are those post surgery/chemotherapy for ovarian cancer usually monitored?

A
  • CA 125 levels

- CT scans

52
Q

List 3 poor prognostic indicators:

A
  • ^ age
  • Poorly differentiated tumours
    Poor response to tumours
53
Q

What type of gynaelogical cancer causes the most deaths?

A

Ovarian cancer.

54
Q

List the 3 most common gynae cancers:

A
  • Uterine cancer
  • Ovarian cancer (most deaths)
  • Cervical cancer (most common in young women, <35yrs)
55
Q

What is the definition of palliative care?

A

The active total care of the patient whose disease is incurable.

56
Q

What are the aims of palliative care?

A
  • Increase QoL
  • Symptoms control
  • Addressing social, psychosocial and spiritual needs
57
Q

Outline the WHO analgesic ladder:

A

-NSAIDs
- Mild opioids (codeine)
- Moderate opioids (codeine ^)
- Strong opioids (morphine)
(consider behavioural techniques or alternative therapies (acupuncture etc…)

58
Q

List 5 issues/symptoms which need to be addressed in palliative care:

A
  • Pain
  • Nausea and vomiting
  • Heavy vaginal bleeding
  • Ascites and bowel obstruction
  • Terminal distress (last 24hrs memorable for family)

Gynae (8 decks)

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