Ovary Flashcards

1
Q

epidemiology

A

more common in white females
58% have advanced disease
4% of all cancers in females

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2
Q

what are the protective measures

A

pregnancy
breast feeding
high parity
oral contraceptive: reduce the number of ovulations
late menarch and early menopause

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3
Q

aetiology

A

long term trauma to the ovary
early menarche and late menopuase
diabetes
infertility or nullipartility
hormone replacement therapy
obesity
smoking
endometriosis
family history
genetics: BRCA 1/2 mutations, lynchs syndrome

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4
Q

what is the most common pathology

A

epithelial 85% (arises from surface epithelial, it can either be cystic or solid)

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5
Q

what is the other pathology type

A

germ cell: dysgerminsomas, teratomas and sex cord and granulose cell tumours

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6
Q

symptoms

A

persistent bloating
difficulty eating, feeling full quickly
abdominal, pelvic pain
frequency and urgency
loss of appetite
nausea
weight change
abnormal vaginal bleeding
pain during sex
changes in bowel and bladder habits
breathlessness

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7
Q

investigation

A

PV clinical examination to feel abnormalities in the ovaries
transvaginal ultrasound to visualise ovaries
blood tests: FBC, LFT, U&E
test for CA 125 cancer antigen protein which is produced by ovarian tumours, if this is higher further tests are needed. If the tumour does produce this, it can be monitored and its treatment response.

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8
Q

what does CT and MRI do?

A

extent of local and nodal spread

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9
Q

transcoelomic spread

A

through the peritoneum, spread through the abdomen, may cause ascites

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10
Q

FIGO staging system

A

stage I = confined in the ovary
IA = 1 ovary involved
IB = both involved
IC = peritoneal cytology +/ capsule ruptured/ cells on the ovary surface
stage II = one or both pelvic extension
stage III = one or both spread to the abdominal cavity/ peritoneal deposits
stage IV = blood borne mets

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11
Q

how is IA + IB managed

A

total abdominal hysterectomy + bilateral salpingo-oopharectomy

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12
Q

how is IC managed

A

adjuvant chemo with cis platinum to carbo after surgery

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13
Q

how is stage II & III managed

A

surgery + chemo: cis or carbo + paclitaxel, neoadjuvant may be given to reduce tumour volume before resection

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14
Q

how is IV managed

A

palliative treatment (same as II + III), RT can be offered

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15
Q

what is palliative RT

A

symptom control
POP
low dose and fraction, 20Gy in 5

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16
Q

ovarian tetratoma

A

benign or malignant
if malignant it is only fairly chemo sensitive

17
Q

sex cord and granulosa

A

produce hormones so tend to present early, treatment is TAH + BSO, if unaffected the ovary can be persevered. These tend come back with intra-abdominal met which can occur 30 years after initial diagnosis

18
Q

what is dysgerminoma

A

present at an early stage which is when there is enlargement in the abdomen and pain. Treatment is surgery, with a good prognosis.
CHEMOSENSITIVE