The ovary and its disorders

Question 1

What are the 3 ovarian cyst “accidents”?

Answer 1

Rupture
Haemorrhage
Torsion

Question 2

What gene mutations predispose to ovarian cancer risk?

Answer 2

BRCA 1 and 2 gene mutations - associated with breast cancer as well (BRCA 1 = 50% lifetime risk of ovarian cancer)
HNPCC gene mutation - associated with bowel cancer

Question 3

Protective and risk factors of ovarian cancer

Answer 3

Protective: COCP, pregnancy, lactation
Risk: early menarche, late menopause and nulliarity

Question 4

What stage do most patients present with ovarian tumours?

Answer 4

70% present late stage

Question 5

What symptoms to women start to present with in late stages?

Answer 5

Persistent abdominal distention (bloating) 
Feeling fully (early satiety)
Loss of appetite 
Pelvic or abdominal pain
Increased urinary urgency/frequency

Question 6

What signs hint him towards malignant ovarian tumours?

Answer 6

Rapid growth
Bilateral 
Ascites
Advanced age
Solid or septate nature on US
Increased vascularity

Question 7

What are the stages of ovarian cancer?

Answer 7

Stage 1 - disease macroscopically confined to the ovaries
Stage 2 - disease extending to pelvis
Stage 3 - abdominal disease and/or affected lymph nodes
Stage 4 - disease is beyond the abdomen, e.g. in the lungs or liver parenchyma

Question 8

What is used to detect ovarian cancer?

Answer 8

Measure CA 125 levels.
If high, do ultrasound of the abdomen and pelvis.
If US identifies ascites or any pelvic mass, there is urgent referral to secondary care.
AFP and hCG are measured in women <40 years to identify those who do not have epithelial cancer.
CT is performed to measure extent of disease.

Question 9

What is the risk of malignancy score used for and how is it calculated?

Answer 9

Used for ovarian cancer.

Calculated = ultrasound score x menopausal score x CA 125 serum levels.

Question 10

Treatments for ovarian cancer

Answer 10

Total hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy is performed.
If saving fertility - leave uterus and remaining unaffected ovary.
Chemotherapy (not used in very early stage) - CA 125 levels used to record response.
Many women have chemotherapy and halfway through the course have surgery - less morbidity.

Question 11

What percentage of women are cured from ovarian cancer?

Answer 11

30%

Question 12

What are the 3 types of ovarian cancer and which is most common?

Answer 12

Epithelial (most common - 95%)
Germ cell
Sex cord