Women's Health- Ovaries

Question 1

what are the common s/s of Ovarian and adnexal Disease?

Answer 1

Vague GI discomfort

Pelivic pressure and pain

May be asymptomatic

Question 2

What is the mainstay of dx of Ovarian and adnexal Disease?

Answer 2

Pelic examination and ultrasound

Question 3

Ovaries are not suppose to be palpable after menopause, if they are what should you do?

Answer 3

Further dx!

Question 4

Are Ovarian Tumors common?

Answer 4

Yes most are benign

Question 5

Malignant ovarian tumors are the leading cause for death of the reproductive tract, what are the risk factors for developing the malignant ovarian tumors?

Answer 5

Family history with BRCA1 and BRCA2 gene mutation ( BRCA1 is higher risk)

Question 6

What are the clinical manifestations of Ovarian cancer?

Answer 6

Most: asymptomatic

Mild nonspecific GI symptoms or pelvic pressure

Early disease- detected on routine pelvic examination

Advanced malignant disease- abdominal pain and bloating- palpable abdominal mass with ascities is often present

Question 7

What are the laboratory findings for Ovarian cancer?

Answer 7

CA-125- tumor marker to distinguish between benign and malignant pelivic masses( sensitie but not specific) 
Other markers
hCG
Lactate Dehydrogenase
Alpha fetoprotein

Question 8

What imaging studies are done for Ovarian cancer?

Answer 8

Transvaginal ultrasound- useful for high risk women- inadequate sensitivity for screening low risk women ( helpful in dx malignancy and benign)

Question 9

What is the treatment of Ovarian Cancer?

Answer 9

Surgical evaluation by Gyneocolic Oncologist

If it is malignant: complete surgical staging plus
Abdominal hysterectomy andbilateral salpingoophorectomy with omenetomy and selective lymphadenectomy and possible post op chemo

If it is benign: Tumor is removed unilateral oophorectomy

Question 10

What is the prognosis of Ovarian cancer?

Answer 10

75% diagnosed with ovarian cancer in advanced stages ( 5 year survival rate 17% with distant mets, 36% with local spread, 89% with early disease)

Question 11

Functional Ovarian Cyst:

Answer 11

Functional Ovarian Cyst:

Question 12

What is a Functional Ovarian Cyst?

Answer 12

Variation due to normal ovulation

can be quite large, they still are usually less than 10 cm in size

generally asymptomatic unless bleeding or torsion occurs.

Most will spontaneously resolve within a few weeks but some will persist for several months.

Question 13

There are two types of Functional Ovarian Cyst, what are they?

Answer 13

Follicular cyst- failure of ovulation, follicle continues to grow

Corupus Leteum cyst corpus luteum fails to involute- continues to enlarge after ovulation

Question 14

What does a follicular cyst look like on ultrasound?

Answer 14

shows up as smooth thin walled, and unilocular on ultrasound

Question 15

What do Corpus luteum cyst look like?

Answer 15

complex and grossly are yellow

Question 16

Follicular Cysts:

Answer 16

Follicular Cysts:

Question 17

What is the most common functional cyst?

Answer 17

Follicular cysts

Question 18

What is the common size of follicular cyst?

Answer 18

3-8 cm

Question 19

what are the signs and symptoms of follicular cyst and how are they normally treated?

Answer 19

Can be painful, generally resolve on their own over one or two cycles.

Question 20

What if the follicular cyst do not resovle on their own?

Answer 20

Surgical intervention, BCP can prevent the formation.

Question 21

What will the pelvic exam on a follicular cyst show?

Answer 21

Bomanual exam will have a tender painful mass.

Question 22

What must you always r/o when thinking follicular cyst?

Answer 22

Pregnancy

Question 23

Corpus Leteum Cysts

Answer 23

Corpus Leteum Cysts

Question 24

What is the size of a Corpus Leteum Cysts?

Answer 24

Larger than 3 cm

Question 25

What are Corpus Leteum Cysts related to?

Answer 25

The progesterone dominate phase of the cycle

Question 26

How do Corpus Leteum Cysts come about?

Answer 26

They evolve rapidly and are hemorrhagic, may be associated with ovarian torsion- severe pain

Question 27

What is the treatment of Corpus Leteum Cysts?

Answer 27

o Unless acute complications treatment is symptomatic (OCP may work)

o Laparoscopy or laparotomy usually is required to control hemorrhage into the peritoneal cavity and or detorison of the adnexa

Question 28

Benign Ovarian Neoplasm:
• define:
• In premenopausal women:
• Post menopausal-

Answer 28

• Functional cysts make up the majority of ovarian masses- however 25% are nonfunctional neoplasm
• In premenopausal women 90% of these are benign
• Post menopausal- only 75% are benign

Question 29

Theca Lutein Cyst

Answer 29

Theca Lutein Cyst

Question 30

What is a Theca Lutein Cyst ?

Answer 30

Elevated levels of Chorionic gonadotropin, the cysts will be lined by theca cells, usally bilaterally and filled with clear straw colored fluid.

Question 31

What are the symptoms of Theca Lutein Cyst ?

Answer 31

Abdominal symptpms are rare

Question 32

Theca Lutein Cyst are associated with what?

Answer 32

Pregnancy, Multiple gestations, Trophoblastic disease, Clominphene use

Question 33

Benign Ovarian Neoplams:

Answer 33

Tumors are often clinically silent until well developed- may be solid, cystic, or miexed and they may be functional (prdoducing sex steroids) or nonfunctional

Question 34

What increases the malignancy of benign ovarian neoplasms?

Answer 34

Increased age – postmenopausal patients warrant comprehensive evaluation and follow up.

Question 35

What are risk factors for developing benign ovarian neoplasms?

Answer 35

Cigarette smoking doubles the relative risk, menarche, obesity, infertility and hypothyroidism

Question 36

What are risk factors for ovarian cancer?

Answer 36

o Age over 60 
o Early menarche
o Late menopause
o Nulligravity infertility
o Enometriosis
o Polycystic ovarian syndrome 
o Family hx of ovarian ca

Question 37

Treatment of ovarian tumors:

Answer 37

Medication: OTC, Fist line NSAIDS or Narcotics

Surgery: Cystectomy with wedge resection