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Gynaecology > Ovary and its disorders > Flashcards

Ovary and its disorders Flashcards

1
Q

what secures the ovaries in place

A

broad ligament
ovarian ligament
pelvic side wall via infundibulopelvic ligament

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2
Q

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

A

outer cortex - theca cells/follicles

inner medulla - connective tissue and blood vessels

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3
Q

what cell produce oestrogen in the ovary

A

theca cells/granulosa cells

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4
Q

what causes the corpus luteum to maintain itself in pregnancy

A

b-hcg from the trophoblast

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5
Q

what causes follicular and lutean cysts

A

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

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6
Q

what are the common symptoms from ovarian masses

A

abdominal distention/bloating

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7
Q

what are the features of ovarian cyst rupture

A

intense abdominal pain

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8
Q

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

A

epithelial

germ cell

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9
Q

what population is epithelial cell tumours mainly found in

A

post menopausal women

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10
Q

what are the subtypes of epithelial cell tumours in ovarian cancer

A 
borderline 
serous cystadenoma 
mucinous cystadenoma 
endometroid 
clear cell 
brenners tumours
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11
Q

what are the features of borderline ovarian tumours

A

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

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12
Q

what is the most common malignant ovarian tumour

A

serous cystadenoma

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13
Q

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

A

because the cysts commonly become malignant

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14
Q

what % of all ovarian tumours are endometrioid

A

25%

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15
Q

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

A

endometrial cancer

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16
Q

what % of ovarian tumours are clear cell

A

<10%

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17
Q

what is the prognosis of clear cell epithelial tumours

A

poor

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18
Q

what do germ cell tumours of the ovary originate from

A

undifferentiated primordial cells of the gonad

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19
Q

what are the subtypes of germ cell tumours

A

teratoma

dysgerminoma

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20
Q

what are features of teratomas

A

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

21
Q

what are features of dysgerminomas

A

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

22
Q

what are the subtypes of sex cord ovarian tumours

A

granulosa cell tumours
thecal cell tumours
fibromas

23
Q

what are features of granulosa cell ovarian tumours

A

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

24
Q

what are features of theca cell ovarian tumours

A

rare
benign
secretes androgens

25
Q

what are features of fibroma ovarian tumours

A

rare and benign

causes meig’s syndrome

26
Q

what is meig’s syndrome

A

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

effusion fixed with cyst removal

27
Q

what % of ovarian tumours are secondary malingancies

A

10%

28
Q

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

A 
endometriotic cysts 
functional cysts (lutean/follicular)
29
Q

how should you manage functional cysts

A

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

30
Q

what is the 10 year survival of ovarian cancer

A

50%

31
Q

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

A

> 50

32
Q

what is the lifetime risk of ovarian cancer

A

1 in 60 (1.67%)

33
Q

what type are 95% of ovarian cancers

A

epithelial

34
Q

what are risk factors for ovarian cancer

A

early menarche
late menopause
nulliparity

essentially high exposure to oestrogen

35
Q

what are protective factors for ovarian cancer

A

pregnancy
OCP
lactation

36
Q

what genes are linked with ovarian cancer

A

BRCA1/2

HPNCC

37
Q

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

A

stage 3

38
Q

what are signs of ovarian cancer

A

bloating
early satiety
pelvic/abdominal pain
increased urinary frequency

39
Q

what are important questions to ask if you suspect ovarian cancer

A

breast/GI symptoms for common mets

40
Q

what is the staging of ovarian cancer

A

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

41
Q

how do you investigate ?ovarian cancer

A

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

42
Q

what is the management of confirmed ovarian cancer

A 
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

43
Q

when is chemo offered in ovarian cancer

A

stage 1c+

high grade

44
Q

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

A

Ca125

45
Q

what is the deadliest gynaecological carcinoma

A

ovarian

46
Q

what are poor prognostic markers for ovarian carcinoma

A

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

47
Q

what is the most common mechanism of death with ovarian carcinoma

A

bowel obstruction/perforation

48
Q

what is the 5 years survival of ovarian cancer by stage

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

Gynaecology (14 decks)

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