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Reproduction > Week 6- ovarian cancer > Flashcards

Week 6- ovarian cancer Flashcards

1
Q

What are the main groups that cause ovarian pathology?

A

Cysts

Endometriosis

Tumours

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2
Q

Where can ovarian cysts arise from?

A

They can arise from any element of the ovary. Follicular- e.g. polycystic ovaries

Luteal

Endometriotic

Epithelial

Mesothelial- these are uncommon.

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3
Q

Describe a follicular cyst?

A

The follicle doesn’t rupture and grows until it forms a cyst. They are thin walled and lined by granulosa cells.

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4
Q

At what point in the cycle do follicular cysts occur at?

A

They occur when ovulation doesn’t happen e.g. the follicle doesn’t rupture and the oocyte isn’t released.

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5
Q

Are follicular cysts common?

A

Yes.

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6
Q

Do follicular cysts grow? if so to what size? Do they need treatment?

A

They can grow to several cms in size. If they grow, that may be a worrying sign. They usually resolve themselves within a few months.

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7
Q

What is endometriosis?

A

Endometrial glands and ströma outwit the uterine cavity.

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8
Q

What symptoms/signs can endometriosis cause?

A

May cause infertility, pelvic inflammation and pain.

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9
Q

If endometriosis occurs in the ovary, what is it known as?

A

Chocolate cysts.

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10
Q

What other sites can endometriosis commonly affect?

A

Pouch of Douglas

Peritoneal surfaces- including uterus (not inside on the outside)

Cervix, vulva, vagina

Bladder, bowel.

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11
Q

What is endometriosis in the myometrium known as?

A

Adenomyosis.

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12
Q

Describe the pathogenesis of endometriosis?

A

Three steps- Regurgitation: glands in the stroma shed in the endometrial cavity each month. These somehow manage to get up the Fallopian tubes and into other body cavities

Metaplasia-transition from one epithelial cell type to another

Then vascular or lymphatic dissemination.

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13
Q

Macroscopically, how does endometriosis look?

A

Peritoneal spots or nodules

Fibrous adhesions

Chocolate cysts.

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14
Q

Microscopically, how does endometriosis look?

A

Endometrial glands and stroma.

Haemorrhage, inflammation and fibrosis.

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15
Q

What complications can occur with endometriosis?

A

Pain

Cyst formation

Adhesions- inflammation can cause adhesions with the bowel etc.

Infertility- if it involves the Fallopian tube or ovary

Ectopic pregnancy

Malignancy

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16
Q

Which cancers is endometriosis a precursor for?

A

Endometroid adenocarcinoma or clear cell carcinoma.

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17
Q

Where can ovarian tumours arise from? (tissues)

A

Epithelial Germ cell

Sex cord/stromal

Metastatic

Miscellaneous

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18
Q

What makes up epithelial ovarian tumours?

A

As the ovary doesn’t have epithelium, its always from somewhere else. These include:

  • Serous
  • Mucinous- mesothelium over the surface of the ovary. When the follicle ruptures it can become embedded in the stroma and become metaplastic. -Endometroid- get there by endometriosis
  • Clear cell- get there by endometriosis
  • Brenner -Undifferentiated carcinoma. These are all thought to be tubal in origin- e.g. something in the tubes falling onto the ovary.
19
Q

Epithelial ovarian tumours are classified as benign, borderline or malignant. Describe each.

A

Benign- No cytological abnormalities. Proliferative activities absent or scant. No stromal invasion

Borderline-Cytological abnormalities. Proliferative. No stroll invasion Malignant- cytological abnormalities.

Proliferative. Stromal invasion.

20
Q

How can serous carcinoma be classified?

A

As high grade serous carcinoma or low grade serous carcinoma.

21
Q

Describe high grade serous carcinoma?

A

Serous tubal intraepithelial carcinoma (STIC)

Most are tubal in origin.

22
Q

Describe low grade serous carcinomas?

A

Serous borderline tumour.

23
Q

This pic tells you where the stroma is.

A
24
Q

This is a high grade serous carcinoma.

A
25
Q

Which two cancers have strong associations with endometriosis of the ovary?

A

Clear cell and endometroid.

26
Q

What other disease are endometroid carcinomas associated with?

A

Lynch syndrome.

NOTE- most are low grade and early stage. Graded the same as uterine tumours.

27
Q

How do you diagnose endometroid and clear cell carcinomas?

A

Primary diagnosis is on ascitic fluid (these women tend to be distended and have lots of ascites).

28
Q

In surgical removal of a cyst, what do you have to be careful not to do?

A

Pop the cyst- as this allows spread of cells elsewhere in the body (metastases)

29
Q

Describe brenner tumours?

A

A tumour of transitional type epithelium (bladder) that is usually benign. Borderline and malignant variants are rare.

30
Q

What percentage of all ovarian tumours do germ cell tumours make up?

What two common types of germ cell tumour are there?

A

15-20%

Teratomas and dermoid cysts (now called mature cystic teratomas) (95%)

31
Q

Describe dermoid cysts (mature cystic teratomas)?

Are they benign, borderline or malignant?

A

They are cystic and contain sebum or hair. They can arise from the ectoderm, endoderm or mesoderm. They can contain respiratory, gut, skin and fat tissues.

They rarely become malignant.

32
Q

What other types of germ cell tumours are possible?

A

Immature teratoma

Dysgerminoma

Yolk sac tumour

Choriocarcinoma

Mixed germ cell tumour.

33
Q

What is the most common malignant germ cell tumour?

A

Dysgerminoma.

34
Q

What three types of tumour make up the sex cord/stromal tumours?

A

Fibroma/thecoma

Granulosa cell tumour

Sertoli-Leydig cell tumours

35
Q

Describe fibromas/thecomas?

A

They are benign tumours that may produce oestrogen causing uterine bleeding.

36
Q

Describe granulosa cell tumours?

A

These are all potentially malignant. May also be associated with oestrogenic manifestations.

37
Q

Describe sertoli-Leydig cell tumours?

A

These are rare, but may produce androgens.

38
Q

Where are the commonest places that metastases in the ovaries arise from?

A

Stomach

Colon

Breast

Pancreas

Metastatic spread should be considered in all cases, especially when tumours are bilateral and small.

39
Q

Describe the figo staging of ovarian cancer?

A

1A- tumour in one ovary

1B- tumour confined to both ovaries

1C- cancer involving ovarian surface/rupture/surgical spill/tumour in washings

2A- extension/implantation on uterus/fallopian tube.

2B-Extension to other pelvic intraperitoneal.

3A-retroperitoneal lymph node metastases or microscopic extrapelvic involvement

3B-macroscopic peritoneal metastasis beyond pelvis up to 2cm in dimension.

3C-macroscopic peritoneal metastasis >2cm in dimension

4-distant metastasis.

40
Q

Next bit of figo staging.

A
41
Q

What is inflammation of the fallopian tubes called?

A

Salpingitis.

42
Q

What pathology can affect the fallopian tube?

A

Inflammation
Cysts and tumours

Serous tubal intraepithelial carcinoma

Endometriosis

Ectopic pregnancy

43
Q

What is ectopic pregnancy?

Where does it commonly occur?

A

Implantation of the conceptus outside the uterine cavity.

Commonly occurs in the fallopian tube. However may occur in ovary or peritoneum.

Reproduction (34 decks)

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