The ovary and its disorders Flashcards
Ovaries are attached to the broad ligament by
mesovarium
Ovaries are attached to the pelvic side wall by
infundibulopelvic ligament
Ovaries are attached to the uterus by
ovarian ligament
Blood supply to ovary is by
ovarian artery and uterine artery branch
Acute presentation of ovary pathology is often due to
ovarian cyst accidents
Ovarian intense pain- whats happened?
ruptured contents into peritoneal cavity- dermoid/endometrioma
Peritoneal cavity haemorrhage can lead to…
hypovolemic shock
How does PCOS present?
oligomenorrhoea, hirsutism, subfertility
Premature menopause is…
Last period before 40
Classification of ovarian tumours
Primary-epithelial, germ cell, sex cord. Secondary malignancies.
Most common malignant ovarian neoplasm
50% serous cystadenoma or adenocarcinoma
Epithelial tumours are formed from which layer in what age group
outermost epithelial layer, in post menopausal women
How do epitheliod ovarian tumours progress?
Borderline malignancy (no invasion) may progress to frank malignancy
Optimum management of ovarian epitheliod tumours is disputed. What would you do for a young woman with borderline cyst
Removal of just cyst to preserve fertility. Recurrence can occur upto 20 years.
What is a malignant epethelial tumour of the ovaries that can become large but less frequently malignant? What % prevalence?
10% Mucinous cystadenoma/adenocarcinoma.
What is a borderline variant of Mucinous cystadenoma- what happens in it?
Mucinous cystadenoma- pseudomyxoma peritonei- abdo cavity filled with gelatinous mucin secretions.
What is a malignant variant of epithelial ovarian tumour that is histologically similar to endometrial carcinoma? epidemiology.
Endometriod carcinoma, 25% ovarian cancers, 20% associated with EndoM Ca
Clear cell carcinomas of the ovary are…
malignant variant that accounts for <10% ovarian cancers but poor prognosis
Brenner tumours are…
Benign rare and small ovarian cancers
Where do germ cell tumours of the ovary arise?
Undifferentiated primordial germ cells of the gonad
Teratomas are
Common benign germ cell tumour sometimes with fully differentiated tissue of all cell lines like hair and teeth.
Teratomas present in/as
Young premenopausal women Bilateral, large and often asymptomatic. Rupture is painful.
Dysgerminoma presentation
Rare but most common ovarian malignancy in younger women
Dysgerminoma is the female equivalent of the
Seminoma, germ cell tumour
Granulosa cell tumours are
Sex cord tumours
Sex cord tumours arise from the
Stroma of the gonad
Granulosa cell tumours most commonly found in
post menopausal women
Granulosa cell tumours
Usually malignant but slow growing and rare
Whats a good tumour marker for granulosa cell tumours?
Serum inhibin levels
Granulosa cell tumours secrete
high levels of oestrogens and inhibins which stimulate the endometrium causing- bleeding, endometrial hyperplasia–>malignancy and rarely precocious puberty
What are fibromas?
Rare and benign sex cord tumours of the ovary
What are thecomas and what do they secrete?
Rare benign sex cord ovarian tumours that produce oestrogens and androgens
What are 4 common premenopausal ovarian masses?
Follicular/lutein cysts
Dermoid cysts
Endometriomas
Benign epithelial tumour
Fibromas cause a specific syndrome- name it and what happens?
Meigs’ syndrome- ovarian mass + ascites + right pleural effusion
What are dermoid cyts?
Benign cystic teratoma that contains developmentally mature skin complete with hair follicles and sweat glands
What are the 2 post menopausal causes of ovarian masses?
Benign epithelial tumour
Malignancy
Two places that ovaries get mets from
GI and breast
What % of ovarian cancers are secondary
10%, poor prognosis
What are Krukenberg tumours
Secondary mets from gut- containing signet ring cells
What are endometriomas?
endometriotic cysts in ovaries, rupture is painful
What are endometriotic cysts?
Chocolate cysts- contain altered blood
What are the two types of functional cysts and which is more symptomatic?
Follicular cysts and lutein cysts- persistently enlarged follicles and corpus lutea. Lutein cysts are more symptomatic.
What is protective for functional cysts
COCP- inhibits ovulation
Who get functional cysts
premenopausal women
Treatment for functional cysts
None required with no symptoms- obeserved with serial ultrasounds. If >5cm persists beyond 2 months- CA125 is measured and laparoscopy considered to remove/drain the cyst.
3 risk factors and 3 protective factors for ovarian cancer and why
Early menarche, late menopause, nulliparity
Pregnancy lactation, COCP
Genetic component of ovarian cancer?
5% familial with BRCA1, 2 genes/ HNPCC
Does Ovarian cancer have screening?
Not yet, trial of 20000 women going on. TVS/CA125/Observation
What do you offer to women with a family history of ovarian cancer?
Couselling and genetic testing for BRCA. if positive- yearly tvs/ca125 or prophylactic BSO
What % of women present at stage 3/4?
70%
Which GI condition does Ovarian cancer present as and what are the symptoms?
IBS- Bloating, distention/mass, early satiety, loss of appetite, pelvic/abdominal pain, increased urgency or frequency.
What is the spread of ovarian adenocarcinoma called
transcoelomic spread
How do you stage ovarian cancer?
Stage 1 ovaries only a)1 b)both c)capsule not intact cells in cavity-ascites
Stage 2 confined to pelvis
Stage 3 confined to abdomen- omentum, small bowel peritoneum
Stage 4 beyond abdomen- liver/lungs
How would you investigation a suspicion of ovarian cancer from IBS symptoms in old age?
CA125 level if >35IU/ml, US abdo-pelvis, mass or ascites= urgent secondary care referral. Under 40- AFP/hCG measured (germ cell tumours), calculate RMI. >250= specialist MDT team- CT abdo-pelvis, further stage by surgery
How is ovarian cancer managed?
Assess for fitness for surgery- esp elderly women and blood cross matched.
Midline laparotomy- Total hysterectomy-BSO-partial omentectomy with biopsies of peritoneal deposits, peritoneum and retroperitoneal lymph nodes (stage 1). Remove all RPT if stage 2 through block dissection.
Preserve functional ovary + uterus to preserve fertility but monitor meticulously
Chemotherapy- Percutaneous image guided biopsy/laproscopy.
High grade stage 1c- carpoplatin 6 cycles
Stage 2-4- Carboplatin/cisplatin+/- paclitaxel
Only ovairan tumour that is radiotherapy sensitive.
Dysgerminomas.
How do you follow up ovarian cancer post treatment?
CA125 levels, CT scan- residual disease/relapse. Interval debulking. Chemo=short term + QALY
Most common reason for death by ovarian cancer.
Bowel obstruction or perforation
What specific end of life problems with ovarian cancer that need palliation
Heavy vaginal bleeding, Ascites(paracentesis) and bowel obstruction (metoclopramide)
