ovary Flashcards by RK Splendid

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

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blood supply of ovary?

ovarian artery + anastomosis with

branches of uterine artery in broad ligament

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what is the most common site of ovarian ca?

epithelium covering the ovary:

germinal epithelium

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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)

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what is the presenting triad of PCOS?

oligomenorrhoea + hirsutism + sub-fertility

This is not the NICE criteria for what constitutes pcos

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define premature menopause?

Last period before 40 years of age

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which is the most common syndrome of gonadal dysgenesis?

turners syndrome

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most common ovarian epithelial tumour?

serous cystadenoma - adenocarcinoma

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which are the only ovarian tumours to be common in young women?

germ cell tumours

especially dysgerminoma

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list some risk factors for dysgerminoma?

gonadal dysgenesis and androgen insensitivity syndrome

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dysgerminoma is often associated with which biomarkerr changes?

increased:
LDH, ALP, placental ALP

Hypercalcaeemia

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which tumour causes Meigs syndrome -

ascites, right pleural effusion AND small ovarian mass

Fibroma - sex cord stromal tumour

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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.

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see histopath - gynae flashcards for rest of ovarian tumours cards

okay

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rx for germ cell tumours?

Teratoma: surgical

Dysgerminoma: radiotherapy

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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