ovary Flashcards
what are the attachments of the ovary?
Attached to broad ligament by mesovarium
Attached to pelvic wall by infundibulopelvic
ligament
Attached to uterus by ovarian ligament
blood supply of ovary?
ovarian artery + anastomosis with
branches of uterine artery in broad ligament
what is the most common site of ovarian ca?
epithelium covering the ovary:
germinal epithelium
how do ovarian masses present?
usually silent unless a cyst accident occurs:
Rupture, Torsion, Haemorrhage = PAIN
torsion -> infarction -> pain
Sudden onset excruciating pain, “feel like they’ve been shot”
Actually if there is tissue ischaemia or death they may stop feeling pain suddenly.
Depends if its malignant (bloating, IBS symptoms, bowel obstruction sx?), or not (iliac fossa pain)
what is the presenting triad of PCOS?
oligomenorrhoea + hirsutism + sub-fertility
This is not the NICE criteria for what constitutes pcos
define premature menopause?
Last period before 40 years of age
which is the most common syndrome of gonadal dysgenesis?
turners syndrome
most common ovarian epithelial tumour?
serous cystadenoma - adenocarcinoma
which are the only ovarian tumours to be common in young women?
germ cell tumours
especially dysgerminoma
list some risk factors for dysgerminoma?
gonadal dysgenesis and androgen insensitivity syndrome
dysgerminoma is often associated with which biomarkerr changes?
increased:
LDH, ALP, placental ALP
Hypercalcaeemia
which tumour causes Meigs syndrome -
ascites, right pleural effusion AND small ovarian mass
Fibroma - sex cord stromal tumour
what can be some side effects of oestrogen secreting tumours?
stimulation of the endometrium
can cause bleeding,
endometrial hyperplasia,
endometrial malignancy,
rarely, in young girls, precocious puberty.
see histopath - gynae flashcards for rest of ovarian tumours cards
okay
rx for germ cell tumours?
Teratoma: surgical
Dysgerminoma: radiotherapy
rx for granulosa cell tumours?
measure serum inhibin as marker to monitor for recurrence
rx for fibromas?
Removal of ovarian mass -> resolution of effusion
why is ovarian cancer prognosis usually bad?
silent nature of this malignancy causes it to present
late, meaning that the disease is widely metastatic
within the abdomen.
10 year survival 50%
30% cure ratee
what term refers to a malignancy in the ovary that metastasized from a primary site, classically the gastrointestinal tract?
A Krukenberg tumour
which cysts are known as chocolate cysts and why?
endometrioma’s
Endometriosis -> altered blood accumulation in ‘chocolate cysts’
what is Lynch’s syndrome?
Patients present with HNPCC gene mutations & increased risk of:
Bowel, Ovarian and endometrial cancer
what is the rx for functional cysts?
Observe via Ultrasound
if grows >5cm in 2 months:
- measure Ca125 + laparoscopic drainage of cyst
what is the impact of COCP on functiona cysts?
inhibits ovulation so preevents functional cysts.
what can be offered in terms of ovarian ca screening?
prophylactic BSO for BRCA + patients
what is the clinical presentation of ovarian cancer and why?
sincee MOST present at stage 3/4:
persistent abdominal distension, feeling full, loss of appetite, pelvic/abdominal pain,
increased urinary urgency or frequency
Many symptoms similar to IBS
How are ovarian malignancies investigated?
Ca125
US of pelvis and abdomen
Referral to secondary care if mass &; Ca125>35 (only worrying when quite high eeg 90+)
secondary care:
US, Ca125
aFP & hCG (cancer in under 40 y/o)
then calculate risK of malignancy index ->
specialist mdt referral + ct/mri (for staging)
what is the treatment for ovarian cancer?
Overall: Surgery + chemo
- no chemo in stagee 1a + 1b
Surgery: Midline laparotomy: TAH + BSO + partial omentectomy lymph nodes: early stage - take sample later stage: block dissection - remove nodes draining section
Can preserve unaffected ovary and uterus in women who wish to preserve fertility and disease is
early or borderline
Chemotherapy
stage 1c+: carboplatin
stage 2-4: carboplatin or cisplatin alone or +paclitaxel
if unsuitable for surgery, chemo alone
o Paracentesis of ascites
what is thee efficacy of chemo in ovarian cancer?
2/3 of women whose tumours initially respond to first-line chemo will relapse within 2 years of
completing tx
how is response to chemo monitored?
Ca125 used to monitor response to chemotherapy
what is the aim of surgery in ovarian cancer?
remove all signs of macroscopic disease
What do you do if a Simple Cyst ruptures?
No need for lap and drainage or suction of fluid.
Due to type of cyst, and if —- I think less than 5/6cm
How does an ovarian torsion present?
Sudden onset excruciating sharp iliac fossa pain, often but not always
‘Been shot’
Nausea, vomiting
Risk factors for ovarian torsion?
Risk factors include ovarian cysts, ovarian enlargement, ovarian tumors, pregnancy, fertility treatment, and prior tubal ligation
What are the risks of torsion?
Loss of ovary - infarct -> infertility
Bleeding
Risk of torsion in future inc of other ovary
How is torsion ivx and treated?
Abdo exam -
Tenderness and guarding in iliac fossa
Tvus:
May not see anything or may see;
Enlarged hypoechogenic or hyperechogenic ovary
Peripherally displaced ovarian follicles
Free pelvic fluid 80% of cases
Whirlpool sign of twisted vascular pedicle
Definitive diagnosis:
On surgery / laparoscopy
Treatment:
Surgical detorsion
If teen or young woman; oophoropexy considered to reduce recurrence - not much evidence
Fix cause eg cystectomy if cyst is aetiology
