The ovary and its disorders

Question 1

Do ovarian masses often present late or early?

Answer 1

Ovarian masses are often silent and detected when they are very large and cause abdominal distension

Question 2

What ovarian cysts accidents cause severe pain?

Answer 2

Cyst rupture; haemorrhage into a cyst; torsion of the cyst

Question 3

What are some disorders of ovarian function?

Answer 3

Polycystic ovarian syndrome (PCOS); premature menopause or problems of gonadal development

Question 4

How do you classify primary ovarian neoplasms?

Answer 4

Epithelial tumours; germ cell tumours and sex cord tumours

Question 5

What age are epithelial tumours most common?

Answer 5

In postmenopausal women.

Question 6

What is a ‘borderline’ epithelial malignancy?

Answer 6

When malignant histological features are present but invasion is not. They can become malignant.

Question 7

How do you treat ‘borderline’ epithelial malignancy?

Answer 7

They can be monitored in postmenopausal women but in younger women it/the ovary can be removed in order to retain fertility.

Question 8

What is the most common malignant ovarian neoplasm?

Answer 8

Serous adenocarcinoma (50% of malignancies)

Question 9

What are the different adenocarcinomas in epithelial tumours?

Answer 9

Serous and mucinous adenocarcinoma

Question 10

What is clear cell carcinoma?

Answer 10

A malignant variant of endothelial carcinoma that account for less than 10% of ovarian malignancies but has a particularly poor prognosis

Question 11

Where are epithelial ovarian tumours derived from?

Answer 11

The epithelium covering the ovary

Question 12

Where do germ cell tumours originate from?

Answer 12

They originate from the undifferentiated primordial germ cells of the gonads

Question 13

At what age are teratomas/dermoid cysts most common?

Answer 13

Young premenopausal women.

Question 14

What are teratomas/dermoid cysts made of?

Answer 14

They may contain fully differentiated tissue of all cell lines, common hair and teeth.

Question 15

What are some characteristics of teratomas/dermoid cysts?

Answer 15

Commonly bilateral, seldom large and often asymptomatic

Question 16

What is a dysgerminoma?

Answer 16

The female equivalent of the seminoma. Although rare, it is the most common ovarian malignancy in younger women.

Question 17

Where do sex cord tumours originate from?

Answer 17

These originate from the stroma of the gonads

Question 18

What are the characteristics of granulosa cell tumours?

Answer 18

Usually malignant; slow-growing; rare; secrete high levels of oestrogen and inhibin; found in post-menopausal women

Question 19

Are the ovaries a common site for metastases?

Answer 19

Yes, particularly from the breast and GI tract.

Question 20

What is a Krukenberg tumour?

Answer 20

An ovarian tumour metastases from the gut

Question 21

Does ovarian cancer present early or late?

Answer 21

Late, due to the silent night of the malignancy. The 5-year survival rate is below 35%

Question 22

What age is ovarian cancer most common?

Answer 22

Over 80% of cases occur in women over 50 years of age, with the highest age-specific incidence rates in women 80-84

Question 23

What are the risk factors of ovarian cancer?

Answer 23

Family history: mutations of the BRCA1 or the BRCA2 gene

Many ovulations: early menarche, late menopause, nulliparity.

Question 24

What are protective factors of ovarian cancer?

Answer 24

Pregnancy, lactation and the use of the pill

Question 25

What genes can contribute to ovarian cancer risk

Answer 25

BRCA1, BRCA2 and HNPCC (hereditary non-polyposis colorectal cancer)

Question 26

Ovarian cancer is often asymptomatic, but what are the potential symptoms?

Answer 26

abdominal distension and bloating
abdominal and pelvic pain
urinary symptoms e.g. Urgency
early satiety
diarrhoea

Question 27

What disease are ovarian cancer symptoms similar to?

Answer 27

IBS, but IBS rarely presents for the first time in older women so always exclude it when it’s in that age group

Question 28

What other system symptoms must be investigated with ovarian cancer?

Answer 28

Breast and GI symptoms, as it may be primarily from there

Question 29

What blood test is associated with ovarian cancer?

Answer 29

CA125

Question 30

What blood tests are associated with germ cell cancers?

Answer 30

Alpha fetoprotein (AFP) and hCG

Question 31

What are the five aspects of symptom control in palliative ovarian cancer care?

Answer 31

Pain; nausea and vomiting; heavy vaginal bleeding; ascites and bowel obstruction; terminal distress

Question 32

List 5 features of ultrasound (excluding size) of malignant ovarian cysts.

Answer 32

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

Question 33

List the ix done in ovarian cancer.

Answer 33

-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

Question 34

How is ovarian cancer managed?

Answer 34

usually a combination of surgery and platinum-based chemotherapy