Women's Health- Ovaries Flashcards
what are the common s/s of Ovarian and adnexal Disease?
Vague GI discomfort
Pelivic pressure and pain
May be asymptomatic
What is the mainstay of dx of Ovarian and adnexal Disease?
Pelic examination and ultrasound
Ovaries are not suppose to be palpable after menopause, if they are what should you do?
Further dx!
Are Ovarian Tumors common?
Yes most are benign
Malignant ovarian tumors are the leading cause for death of the reproductive tract, what are the risk factors for developing the malignant ovarian tumors?
Family history with BRCA1 and BRCA2 gene mutation ( BRCA1 is higher risk)
What are the clinical manifestations of Ovarian cancer?
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
What are the laboratory findings for Ovarian cancer?
CA-125- tumor marker to distinguish between benign and malignant pelivic masses( sensitie but not specific) Other markers hCG Lactate Dehydrogenase Alpha fetoprotein
What imaging studies are done for Ovarian cancer?
Transvaginal ultrasound- useful for high risk women- inadequate sensitivity for screening low risk women ( helpful in dx malignancy and benign)
What is the treatment of Ovarian Cancer?
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
What is the prognosis of Ovarian cancer?
75% diagnosed with ovarian cancer in advanced stages ( 5 year survival rate 17% with distant mets, 36% with local spread, 89% with early disease)
Functional Ovarian Cyst:
Functional Ovarian Cyst:
What is a Functional Ovarian Cyst?
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.
There are two types of Functional Ovarian Cyst, what are they?
Follicular cyst- failure of ovulation, follicle continues to grow
Corupus Leteum cyst corpus luteum fails to involute- continues to enlarge after ovulation
What does a follicular cyst look like on ultrasound?
shows up as smooth thin walled, and unilocular on ultrasound
What do Corpus luteum cyst look like?
complex and grossly are yellow
Follicular Cysts:
Follicular Cysts:
What is the most common functional cyst?
Follicular cysts
What is the common size of follicular cyst?
3-8 cm
what are the signs and symptoms of follicular cyst and how are they normally treated?
Can be painful, generally resolve on their own over one or two cycles.
What if the follicular cyst do not resovle on their own?
Surgical intervention, BCP can prevent the formation.
What will the pelvic exam on a follicular cyst show?
Bomanual exam will have a tender painful mass.
What must you always r/o when thinking follicular cyst?
Pregnancy
Corpus Leteum Cysts
Corpus Leteum Cysts
What is the size of a Corpus Leteum Cysts?
Larger than 3 cm
What are Corpus Leteum Cysts related to?
The progesterone dominate phase of the cycle
How do Corpus Leteum Cysts come about?
They evolve rapidly and are hemorrhagic, may be associated with ovarian torsion- severe pain
What is the treatment of Corpus Leteum Cysts?
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
Benign Ovarian Neoplasm:
• define:
• In premenopausal women:
• Post menopausal-
- 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
Theca Lutein Cyst
Theca Lutein Cyst
What is a Theca Lutein Cyst ?
Elevated levels of Chorionic gonadotropin, the cysts will be lined by theca cells, usally bilaterally and filled with clear straw colored fluid.
What are the symptoms of Theca Lutein Cyst ?
Abdominal symptpms are rare
Theca Lutein Cyst are associated with what?
Pregnancy, Multiple gestations, Trophoblastic disease, Clominphene use
Benign Ovarian Neoplams:
Tumors are often clinically silent until well developed- may be solid, cystic, or miexed and they may be functional (prdoducing sex steroids) or nonfunctional
What increases the malignancy of benign ovarian neoplasms?
Increased age – postmenopausal patients warrant comprehensive evaluation and follow up.
What are risk factors for developing benign ovarian neoplasms?
Cigarette smoking doubles the relative risk, menarche, obesity, infertility and hypothyroidism
What are risk factors for ovarian cancer?
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
Treatment of ovarian tumors:
Medication: OTC, Fist line NSAIDS or Narcotics
Surgery: Cystectomy with wedge resection
