Ovary and its disorders

Question 1

what secures the ovaries in place

Answer 1

broad ligament
ovarian ligament
pelvic side wall via infundibulopelvic ligament

Question 2

what are the layers of the ovary and what do they contain

Answer 2

outer cortex - theca cells/follicles

inner medulla - connective tissue and blood vessels

Question 3

what cell produce oestrogen in the ovary

Answer 3

theca cells/granulosa cells

Question 4

what causes the corpus luteum to maintain itself in pregnancy

Answer 4

b-hcg from the trophoblast

Question 5

what causes follicular and lutean cysts

Answer 5

persistence of the follicles/lutean cysts in women who arent pregnant

Question 6

what are the common symptoms from ovarian masses

Answer 6

abdominal distention/bloating

Question 7

what are the features of ovarian cyst rupture

Answer 7

intense abdominal pain

Question 8

what are the types of primary tumours that may occur in the ovary

Answer 8

epithelial

germ cell

Question 9

what population is epithelial cell tumours mainly found in

Answer 9

post menopausal women

Question 10

what are the subtypes of epithelial cell tumours in ovarian cancer

Answer 10

borderline 
serous cystadenoma 
mucinous cystadenoma 
endometroid 
clear cell 
brenners tumours

Question 11

what are the features of borderline ovarian tumours

Answer 11

malignant features with no invasion, surgery advised but watch and wait adopted in younger women, may recur up to 20 years later

Question 12

what is the most common malignant ovarian tumour

Answer 12

serous cystadenoma

Question 13

why are benign cysts and primary tumours of the ovary classified together

Answer 13

because the cysts commonly become malignant

Question 14

what % of all ovarian tumours are endometrioid

Answer 14

25%

Question 15

what do 20% of patients with endometrioid ovarian tumours also have

Answer 15

endometrial cancer

Question 16

what % of ovarian tumours are clear cell

Answer 16

<10%

Question 17

what is the prognosis of clear cell epithelial tumours

Answer 17

poor

Question 18

what do germ cell tumours of the ovary originate from

Answer 18

undifferentiated primordial cells of the gonad

Question 19

what are the subtypes of germ cell tumours

Answer 19

teratoma

dysgerminoma

Question 20

what are features of teratomas

Answer 20

common benign tumour in premenopausal women containing fully differentiated parts of human tissue - hair/teeth

usually bilateral

not usually large

usuall asymptomatic but rupture may be painful

Question 21

what are features of dysgerminomas

Answer 21

female version of a seminoma
rare
most common ovarian malignancy in younger women
very responsive to radiotherapy

Question 22

what are the subtypes of sex cord ovarian tumours

Answer 22

granulosa cell tumours
thecal cell tumours
fibromas

Question 23

what are features of granulosa cell ovarian tumours

Answer 23

malignant but slow growing
post menopausal
rare
release oestrogen and inhibin causing: bleeding, endometrial malignancy, endometrial hyperplasia and precocious puberty

Question 24

what are features of theca cell ovarian tumours

Answer 24

rare
benign
secretes androgens

Question 25

what are features of fibroma ovarian tumours

Answer 25

rare and benign | causes meig's syndrome

Question 26

what is meig's syndrome

Answer 26

disease caused by fibromas of the ovary ascites and right pleural effusion in conjunction with a small ovarian cyst effusion fixed with cyst removal

Question 27

what % of ovarian tumours are secondary malingancies

Answer 27

10%

Question 28

what are the 2 types of cysts commonly seen on the ovaries

Answer 28

``` endometriotic cysts functional cysts (lutean/follicular) ```

Question 29

how should you manage functional cysts

Answer 29

if asymptomatic dont treat if there is one for >2 months, and is >5cm measure Ca125 serially and consider a laparoscopy to drain/remove the cyst

Question 30

what is the 10 year survival of ovarian cancer

Answer 30

50%

Question 31

what age range is the majority (85%) of ovarian cancer patients in

Answer 31

>50

Question 32

what is the lifetime risk of ovarian cancer

Answer 32

1 in 60 (1.67%)

Question 33

what type are 95% of ovarian cancers

Answer 33

epithelial

Question 34

what are risk factors for ovarian cancer

Answer 34

early menarche late menopause nulliparity essentially high exposure to oestrogen

Question 35

what are protective factors for ovarian cancer

Answer 35

pregnancy OCP lactation

Question 36

what genes are linked with ovarian cancer

Answer 36

BRCA1/2 | HPNCC

Question 37

what is the most common (75%) stage that ovarian cancer presents in

Answer 37

stage 3

Question 38

what are signs of ovarian cancer

Answer 38

bloating early satiety pelvic/abdominal pain increased urinary frequency

Question 39

what are important questions to ask if you suspect ovarian cancer

Answer 39

breast/GI symptoms for common mets

Question 40

what is the staging of ovarian cancer

Answer 40

1 - confined to the ovaries 2 - beyond ovaries but confined to pelvis 3 - beyond pelvis but confined to abdomen 4 - disease is beyond the abdomen

Question 41

how do you investigate ?ovarian cancer

Answer 41

If >50 and symptomatic ``` Measure CA125 (normal = <35 IU/ml) If raised abdo/pelvic USS is indicated If the USS identifies a mass or ascites urgentsecondary referral is indicated ``` If <40 AFP and betaHCG levels are measure to exclude germ cell tumours Commonly the risk of malignancy index (RMI) is calculated using the USS score (U0-3), menopause status (M1-3) and the CA125 level (RMI = U x M x Ca125) >250 RMI = MDT referral

Question 42

what is the management of confirmed ovarian cancer

Answer 42

``` midline laporotomy + any of bilateral salpingooorphectomy hysterectomy partial omentectomy biopsy - peritoneum, retroperitoneal node, peritoneal deposits ``` if stage 2+ nodes are removed through a block dissection ifenlarged

Question 43

when is chemo offered in ovarian cancer

Answer 43

stage 1c+ | high grade

Question 44

what marker is used to determine response to chemo in ovarian cancer

Answer 44

Ca125

Question 45

what is the deadliest gynaecological carcinoma

Answer 45

ovarian

Question 46

what are poor prognostic markers for ovarian carcinoma

Answer 46

clear cell tumours poor differentiation advanced stage slow/poor response to chemo

Question 47

what is the most common mechanism of death with ovarian carcinoma

Answer 47

bowel obstruction/perforation

Question 48

what is the 5 years survival of ovarian cancer by stage

Answer 48

``` 1a- 85%+ 1c - 80% 2 - 70% 3 - 40% 4 - 10% ```