The ovary and its disorders Flashcards
Do ovarian masses often present late or early?
Ovarian masses are often silent and detected when they are very large and cause abdominal distension
What ovarian cysts accidents cause severe pain?
Cyst rupture; haemorrhage into a cyst; torsion of the cyst
What are some disorders of ovarian function?
Polycystic ovarian syndrome (PCOS); premature menopause or problems of gonadal development
How do you classify primary ovarian neoplasms?
Epithelial tumours; germ cell tumours and sex cord tumours
What age are epithelial tumours most common?
In postmenopausal women.
What is a ‘borderline’ epithelial malignancy?
When malignant histological features are present but invasion is not. They can become malignant.
How do you treat ‘borderline’ epithelial malignancy?
They can be monitored in postmenopausal women but in younger women it/the ovary can be removed in order to retain fertility.
What is the most common malignant ovarian neoplasm?
Serous adenocarcinoma (50% of malignancies)
What are the different adenocarcinomas in epithelial tumours?
Serous and mucinous adenocarcinoma
What is clear cell carcinoma?
A malignant variant of endothelial carcinoma that account for less than 10% of ovarian malignancies but has a particularly poor prognosis
Where are epithelial ovarian tumours derived from?
The epithelium covering the ovary
Where do germ cell tumours originate from?
They originate from the undifferentiated primordial germ cells of the gonads
At what age are teratomas/dermoid cysts most common?
Young premenopausal women.
What are teratomas/dermoid cysts made of?
They may contain fully differentiated tissue of all cell lines, common hair and teeth.
What are some characteristics of teratomas/dermoid cysts?
Commonly bilateral, seldom large and often asymptomatic
What is a dysgerminoma?
The female equivalent of the seminoma. Although rare, it is the most common ovarian malignancy in younger women.
Where do sex cord tumours originate from?
These originate from the stroma of the gonads
What are the characteristics of granulosa cell tumours?
Usually malignant; slow-growing; rare; secrete high levels of oestrogen and inhibin; found in post-menopausal women
Are the ovaries a common site for metastases?
Yes, particularly from the breast and GI tract.
What is a Krukenberg tumour?
An ovarian tumour metastases from the gut
Does ovarian cancer present early or late?
Late, due to the silent night of the malignancy. The 5-year survival rate is below 35%
What age is ovarian cancer most common?
Over 80% of cases occur in women over 50 years of age, with the highest age-specific incidence rates in women 80-84
What are the risk factors of ovarian cancer?
Family history: mutations of the BRCA1 or the BRCA2 gene
Many ovulations: early menarche, late menopause, nulliparity.
What are protective factors of ovarian cancer?
Pregnancy, lactation and the use of the pill
What genes can contribute to ovarian cancer risk
BRCA1, BRCA2 and HNPCC (hereditary non-polyposis colorectal cancer)
Ovarian cancer is often asymptomatic, but what are the potential symptoms?
abdominal distension and bloating abdominal and pelvic pain urinary symptoms e.g. Urgency early satiety diarrhoea
What disease are ovarian cancer symptoms similar to?
IBS, but IBS rarely presents for the first time in older women so always exclude it when it’s in that age group
What other system symptoms must be investigated with ovarian cancer?
Breast and GI symptoms, as it may be primarily from there
What blood test is associated with ovarian cancer?
CA125
What blood tests are associated with germ cell cancers?
Alpha fetoprotein (AFP) and hCG
What are the five aspects of symptom control in palliative ovarian cancer care?
Pain; nausea and vomiting; heavy vaginal bleeding; ascites and bowel obstruction; terminal distress
List 5 features of ultrasound (excluding size) of malignant ovarian cysts.
Large size (>5cm)
Internal septa
Solid areas
Papillary excrescence – presence of solid mass/solid projections into the cyst cavity
Increased vascularity/blood flow on Doppler USS
List the ix done in ovarian cancer.
-CA125
-NICE recommends a CA125 test is done initially. Endometriosis, menstruation, benign ovarian cysts and other conditions may also raise the CA125 level
-if the CA125 is raised (35 IU/mL or greater) then an urgent ultrasound scan of the abdomen and pelvis should be ordered
-a CA125 should not be used for screening for ovarian cancer in asymptomatic women
ultrasound
Diagnosis is difficult and usually involves diagnostic laparotomy
How is ovarian cancer managed?
usually a combination of surgery and platinum-based chemotherapy
