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Gynaecology > The ovary and its disorders > Flashcards

The ovary and its disorders Flashcards

1
Q

Ovaries are attached to the broad ligament by

A

mesovarium

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2
Q

Ovaries are attached to the pelvic side wall by

A

infundibulopelvic ligament

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3
Q

Ovaries are attached to the uterus by

A

ovarian ligament

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4
Q

Blood supply to ovary is by

A

ovarian artery and uterine artery branch

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5
Q

Acute presentation of ovary pathology is often due to

A

ovarian cyst accidents

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6
Q

Ovarian intense pain- whats happened?

A

ruptured contents into peritoneal cavity- dermoid/endometrioma

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7
Q

Peritoneal cavity haemorrhage can lead to…

A

hypovolemic shock

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8
Q

How does PCOS present?

A

oligomenorrhoea, hirsutism, subfertility

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9
Q

Premature menopause is…

A

Last period before 40

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10
Q

Classification of ovarian tumours

A

Primary-epithelial, germ cell, sex cord. Secondary malignancies.

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11
Q

Most common malignant ovarian neoplasm

A

50% serous cystadenoma or adenocarcinoma

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12
Q

Epithelial tumours are formed from which layer in what age group

A

outermost epithelial layer, in post menopausal women

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13
Q

How do epitheliod ovarian tumours progress?

A

Borderline malignancy (no invasion) may progress to frank malignancy

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14
Q

Optimum management of ovarian epitheliod tumours is disputed. What would you do for a young woman with borderline cyst

A

Removal of just cyst to preserve fertility. Recurrence can occur upto 20 years.

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15
Q

What is a malignant epethelial tumour of the ovaries that can become large but less frequently malignant? What % prevalence?

A

10% Mucinous cystadenoma/adenocarcinoma.

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16
Q

What is a borderline variant of Mucinous cystadenoma- what happens in it?

A

Mucinous cystadenoma- pseudomyxoma peritonei- abdo cavity filled with gelatinous mucin secretions.

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17
Q

What is a malignant variant of epithelial ovarian tumour that is histologically similar to endometrial carcinoma? epidemiology.

A

Endometriod carcinoma, 25% ovarian cancers, 20% associated with EndoM Ca

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18
Q

Clear cell carcinomas of the ovary are…

A

malignant variant that accounts for <10% ovarian cancers but poor prognosis

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19
Q

Brenner tumours are…

A

Benign rare and small ovarian cancers

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20
Q

Where do germ cell tumours of the ovary arise?

A

Undifferentiated primordial germ cells of the gonad

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21
Q

Teratomas are

A

Common benign germ cell tumour sometimes with fully differentiated tissue of all cell lines like hair and teeth.

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22
Q

Teratomas present in/as

A

Young premenopausal women Bilateral, large and often asymptomatic. Rupture is painful.

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23
Q

Dysgerminoma presentation

A

Rare but most common ovarian malignancy in younger women

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24
Q

Dysgerminoma is the female equivalent of the

A

Seminoma, germ cell tumour

25
Q

Granulosa cell tumours are

A

Sex cord tumours

26
Q

Sex cord tumours arise from the

A

Stroma of the gonad

27
Q

Granulosa cell tumours most commonly found in

A

post menopausal women

28
Q

Granulosa cell tumours

A

Usually malignant but slow growing and rare

29
Q

Whats a good tumour marker for granulosa cell tumours?

A

Serum inhibin levels

30
Q

Granulosa cell tumours secrete

A

high levels of oestrogens and inhibins which stimulate the endometrium causing- bleeding, endometrial hyperplasia–>malignancy and rarely precocious puberty

31
Q

What are fibromas?

A

Rare and benign sex cord tumours of the ovary

32
Q

What are thecomas and what do they secrete?

A

Rare benign sex cord ovarian tumours that produce oestrogens and androgens

33
Q

What are 4 common premenopausal ovarian masses?

A

Follicular/lutein cysts
Dermoid cysts
Endometriomas
Benign epithelial tumour

34
Q

Fibromas cause a specific syndrome- name it and what happens?

A

Meigs’ syndrome- ovarian mass + ascites + right pleural effusion

35
Q

What are dermoid cyts?

A

Benign cystic teratoma that contains developmentally mature skin complete with hair follicles and sweat glands

36
Q

What are the 2 post menopausal causes of ovarian masses?

A

Benign epithelial tumour

Malignancy

37
Q

Two places that ovaries get mets from

A

GI and breast

38
Q

What % of ovarian cancers are secondary

A

10%, poor prognosis

39
Q

What are Krukenberg tumours

A

Secondary mets from gut- containing signet ring cells

40
Q

What are endometriomas?

A

endometriotic cysts in ovaries, rupture is painful

41
Q

What are endometriotic cysts?

A

Chocolate cysts- contain altered blood

42
Q

What are the two types of functional cysts and which is more symptomatic?

A

Follicular cysts and lutein cysts- persistently enlarged follicles and corpus lutea. Lutein cysts are more symptomatic.

43
Q

What is protective for functional cysts

A

COCP- inhibits ovulation

44
Q

Who get functional cysts

A

premenopausal women

45
Q

Treatment for functional cysts

A

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.

46
Q

3 risk factors and 3 protective factors for ovarian cancer and why

A

Early menarche, late menopause, nulliparity

Pregnancy lactation, COCP

47
Q

Genetic component of ovarian cancer?

A

5% familial with BRCA1, 2 genes/ HNPCC

48
Q

Does Ovarian cancer have screening?

A

Not yet, trial of 20000 women going on. TVS/CA125/Observation

49
Q

What do you offer to women with a family history of ovarian cancer?

A

Couselling and genetic testing for BRCA. if positive- yearly tvs/ca125 or prophylactic BSO

50
Q

What % of women present at stage 3/4?

A

70%

51
Q

Which GI condition does Ovarian cancer present as and what are the symptoms?

A

IBS- Bloating, distention/mass, early satiety, loss of appetite, pelvic/abdominal pain, increased urgency or frequency.

52
Q

What is the spread of ovarian adenocarcinoma called

A

transcoelomic spread

53
Q

How do you stage ovarian cancer?

A

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

54
Q

How would you investigation a suspicion of ovarian cancer from IBS symptoms in old age?

A

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

55
Q

How is ovarian cancer managed?

A

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

56
Q

Only ovairan tumour that is radiotherapy sensitive.

A

Dysgerminomas.

57
Q

How do you follow up ovarian cancer post treatment?

A

CA125 levels, CT scan- residual disease/relapse. Interval debulking. Chemo=short term + QALY

58
Q

Most common reason for death by ovarian cancer.

A

Bowel obstruction or perforation

59
Q

What specific end of life problems with ovarian cancer that need palliation

A

Heavy vaginal bleeding, Ascites(paracentesis) and bowel obstruction (metoclopramide)

Gynaecology (11 decks)

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