ovary

Question 1

what are the attachments of the ovary?

Answer 1

Attached to broad ligament by mesovarium

 Attached to pelvic wall by infundibulopelvic
ligament

 Attached to uterus by ovarian ligament

Question 2

blood supply of ovary?

Answer 2

ovarian artery + anastomosis with

branches of uterine artery in broad ligament

Question 3

what is the most common site of ovarian ca?

Answer 3

epithelium covering the ovary:

germinal epithelium

Question 4

how do ovarian masses present?

Answer 4

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)

Question 5

what is the presenting triad of PCOS?

Answer 5

oligomenorrhoea + hirsutism + sub-fertility

This is not the NICE criteria for what constitutes pcos

Question 6

define premature menopause?

Answer 6

Last period before 40 years of age

Question 7

which is the most common syndrome of gonadal dysgenesis?

Answer 7

turners syndrome

Question 8

most common ovarian epithelial tumour?

Answer 8

serous cystadenoma - adenocarcinoma

Question 9

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

Answer 9

germ cell tumours

especially dysgerminoma

Question 10

list some risk factors for dysgerminoma?

Answer 10

gonadal dysgenesis and androgen insensitivity syndrome

Question 11

dysgerminoma is often associated with which biomarkerr changes?

Answer 11

increased:
LDH, ALP, placental ALP

Hypercalcaeemia

Question 12

which tumour causes Meigs syndrome -

ascites, right pleural effusion AND small ovarian mass

Answer 12

Fibroma - sex cord stromal tumour

Question 13

what can be some side effects of oestrogen secreting tumours?

Answer 13

stimulation of the endometrium
can cause bleeding,
endometrial hyperplasia,
endometrial malignancy,

rarely, in young girls, precocious puberty.

Question 14

see histopath - gynae flashcards for rest of ovarian tumours cards

Answer 14

okay

Question 15

rx for germ cell tumours?

Answer 15

Teratoma: surgical

Dysgerminoma: radiotherapy

Question 16

rx for granulosa cell tumours?

Answer 16

measure serum inhibin as marker to monitor for recurrence

Question 17

rx for fibromas?

Answer 17

Removal of ovarian mass -> resolution of effusion

Question 18

why is ovarian cancer prognosis usually bad?

Answer 18

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

Question 19

what term refers to a malignancy in the ovary that metastasized from a primary site, classically the gastrointestinal tract?

Answer 19

A Krukenberg tumour

Question 20

which cysts are known as chocolate cysts and why?

Answer 20

endometrioma’s

Endometriosis -> altered blood accumulation in ‘chocolate cysts’

Question 21

what is Lynch’s syndrome?

Answer 21

Patients present with HNPCC gene mutations & increased risk of:

Bowel, Ovarian and endometrial cancer

Question 22

what is the rx for functional cysts?

Answer 22

Observe via Ultrasound

if grows >5cm in 2 months:
- measure Ca125 + laparoscopic drainage of cyst

Question 23

what is the impact of COCP on functiona cysts?

Answer 23

inhibits ovulation so preevents functional cysts.

Question 24

what can be offered in terms of ovarian ca screening?

Answer 24

prophylactic BSO for BRCA + patients

Question 25

what is the clinical presentation of ovarian cancer and why?

Answer 25

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

Question 26

How are ovarian malignancies investigated?

Answer 26

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)

Question 27

what is the treatment for ovarian cancer?

Answer 27

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

Question 28

what is thee efficacy of chemo in ovarian cancer?

Answer 28

2/3 of women whose tumours initially respond to first-line chemo will relapse within 2 years of
completing tx

Question 29

how is response to chemo monitored?

Answer 29

Ca125 used to monitor response to chemotherapy

Question 30

what is the aim of surgery in ovarian cancer?

Answer 30

remove all signs of macroscopic disease

Question 31

What do you do if a Simple Cyst ruptures?

Answer 31

No need for lap and drainage or suction of fluid.

Due to type of cyst, and if —- I think less than 5/6cm

Question 32

How does an ovarian torsion present?

Answer 32

Sudden onset excruciating sharp iliac fossa pain, often but not always

‘Been shot’

Nausea, vomiting

Question 33

Risk factors for ovarian torsion?

Answer 33

Risk factors include ovarian cysts, ovarian enlargement, ovarian tumors, pregnancy, fertility treatment, and prior tubal ligation

Question 34

What are the risks of torsion?

Answer 34

Loss of ovary - infarct -> infertility

Bleeding

Risk of torsion in future inc of other ovary

Question 35

How is torsion ivx and treated?

Answer 35

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