L9: Ovarian Swellings - Pt 2 Flashcards
(88 cards)
1
Q
Spread of Cancer Ovary
A
2
Q
Spread of Cancer Ovary
- Direct
A
To the surrounding genital and extra-genital organs
3
Q
Spread of Cancer Ovary
- Lymphatic
A
the main route of spread in germ cell tumors.
- To pelvic LNs & para-aortic LNs “main”
- Also, to the supraclavicular lymph nodes through the lymphatic channels of the diaphragm
4
Q
Spread of Cancer Ovary
- Blood
A
- Hematogenous spread at the time of diagnosis is uncommon.
- It involves lung, liver, bone, and brain.
5
Q
Spread of Cancer Ovary
- Transcelomic spread & peritoneal seedling
A
Main & earliest mode in epithelial tumors.
- It rarely penetrates intestinal lumen but progressively may agglutinate loops of bowel together → intestinal obstruction
6
Q
Staging of Cancer Ovary
A
7
Q
Staging of Cancer Ovary
- Stage I
A
8
Q
Staging of Cancer Ovary
- Stage II
A
9
Q
Staging of Cancer Ovary
- Stage III
A
10
Q
Staging of Cancer Ovary
- Stage IV
A
11
Q
Complications of ovarian tumors
A
- Torsion of pedicle
- Rupture
- Hemorrhage
- Infection
- Impaction in pelvis
- Intestinal obstruction
- Degeneration
- Meigs’ syndromes
- Malignant changes
- Complications during pregnancy
- Pressure symptoms
- Metastasis of mg one
12
Q
Complications of Cancer Ovary
- Torsion of Pedicle
A
13
Q
Torsion of Pedicle in Ovarian Tumors
- Predisposing factors
A
- Small to moderate size.
- Long pedicle (as dermoid
14
Q
Torsion of Pedicle in Ovarian Tumors
- PPT Factors
A
- straining during defecation or labor.
- Turning over in bed or intercourse.
15
Q
Torsion of Pedicle in Ovarian Tumors
- CP
A
- Acute abdominal pain
- Tender mass in lower abdomen
- Fluid is usually found in peritoneal cavity by US.
16
Q
Torsion of Pedicle in Ovarian Tumors
- TTT
A
17
Q
Rupture in Ovarian Tumors
A
18
Q
Rupture in Ovarian Tumors
- Predisposing factors
A
19
Q
Rupture in Ovarian Tumors
- CP
A
20
Q
Rupture in Ovarian Tumors
- TTT
A
Immediate Laparotomy
21
Q
Incidence of Pseudomyxoma Peritonei
A
Rare Condition
22
Q
Etiology of Pseudomyxoma Peritonei
A
- Mucinous ovarian tumors.
- Well differentiated cancer colon
- Mucocele of appendix.
23
Q
Pathology in Pseudomyxoma Peritonei
A
- The peritoneal cavity is filled with mucinous material - extensive adhesions.
- The condition commonly recurs after laparotomy & evacuation with excision of the ovarian tumor “may be due to chemical peritonitis”.
24
Q
TTT of Pseudomyxoma Peritonei
A
It may need radiotherapy or intra-peritoneal instillation of radio-active isotope.
25
Hemorrhage in **Ovarian Tumors**
- Predisposing Factors
- Torsion of tumor
- Trauma to abdomen
- Infection, Degeneration & Malignant tumors
26
Hemorrhage in **Ovarian Tumors**
- CP
- Acute abdominal pain + collapse + peritonitis
27
Hemorrhage in **Ovarian Tumors**
- TTT
Immediate Laparotomy
28
Infection in **Ovarian Tumors**
29
Infection in **Ovarian Tumors**
- Predisposing Factors
- Puerperium
- Torsion, Hge or tapping of cyst
30
Infection in **Ovarian Tumors**
- CP
FAHM + Severe pain + severe systemic toxemia due to pus
31
Imapction in Pelvis in **Ovarian Tumors**
32
Imapction in Pelvis in **Ovarian Tumors**
- Predisposing Factors
Long pedicle + small
33
Imapction in Pelvis in **Ovarian Tumors**
- PPT Factors
Adhesions or growing pregnancy
34
Imapction in Pelvis in **Ovarian Tumors**
- Complications
- Bladder irritability or urine retention.
- Rectal pressure or constipation.
- Pelvic pain.
- Obstructed labor if pt gets pregnant
35
Intestinal Obstruction in **Ovarian Tumors**
36
Intestinal Obstruction in **Ovarian Tumors**
- Incidence
- Rare è benign tumor common è malignant tumor
37
Intestinal Obstruction in **Ovarian Tumors**
- Etiology
- **Benign tumors:** adhesion
- **Malignant tumors:** adhesion, infiltration, compression or amalgamation of intestinal loops
38
Intestinal Obstruction in **Ovarian Tumors**
- Sequeale
The commonest cause of death in from ovarian cancer
39
Degeneration in **Ovarian Tumors**
40
Degeneration in **Ovarian Tumors**
- Incidence
Occurs è fibroma & large solid tumors
41
Degeneration in **Ovarian Tumors**
- CP
Usually asymptomatic but may result in dull aching pain
42
**Meig's Syndrome** in Ovarian Tumors
Meig's and pseudo Meig's syndrome: mentioned with fibroma.
43
Complications of **Ovarian Tumors**
- malignant Changes
May occur in some benign ovarian tumors (specially serous cystadenoma).
44
Complications of **Ovarian Tumors**
- Complications during Pregnancy
- Abortion or pre-term labor.
- Obstructed labor (if pedunculated tumor is below presenting part).
45
Complications of **Ovarian Tumors**
- Pressure Symptoms
- Dysuria, urine retention, dyschazia, dyspepsia, dyspnea if huge reaching the diaphragm.
- Intestinal obstruction.
46
Complications of **Ovarian Tumors**
- Mets
leading to cachexia, loss of weight, pallor, anemia... etc
47
Dx of **Ovarian Cancer**
48
Symptoms of **Ovarian Cancer**
49
Symptoms of **Ovarian Cancer**
- Asymptomatic
50
Symptoms of **Ovarian Cancer**
- Bleeding
51
Symptoms of **Ovarian Cancer**
- Cachexia & symptoms of distant metastasis.
....
52
Symptoms of **Ovarian Cancer**
- Dys Group
......
53
Symptoms of **Ovarian Cancer**
- Enlargement of abdomen or abdominal distention
54
Symptoms of **Ovarian Cancer**
- Pain
Dull aching pain or acute abdominal pain (in complicated tumors).
55
Symptoms of **Ovarian Cancer**
- Pressure Symptoms
Abdominal & pelvic pressure symptoms (fibroid).
56
Symptoms of **Ovarian Cancer**
- Endocrinal Symptoms
57
Signs of **Ovarian Cancer**
58
Signs of **Ovarian Cancer**
- General
59
Signs of **Ovarian Cancer**
- Abdominal
60
Signs of **Ovarian Cancer**
- Local
There may be normal tissues OR Benign OR malignant criteria...
61
INVx for **Ovarian Cancer**
62
INVx for **Ovarian Cancer**
- Dx
63
INVx for **Ovarian Cancer**
- Mets
.....
64
INVx for **Ovarian Cancer**
- Pre-Operative
....
65
Criteria Suggesting Ovarian Malignancy
## Footnote
HY
66
Criteria Suggesting Ovarian Malignancy
- History
67
History Suggesting Ovarian Malignancy
- Age
68
History Suggesting Ovarian Malignancy
- Dull Pain
69
History Suggesting Ovarian Malignancy
- rate of Growth
70
History Suggesting Ovarian Malignancy
- Back pain
71
History Suggesting Ovarian Malignancy
- Malignant cachexia & symptoms of metastasis.
72
History Suggesting Ovarian Malignancy
- Hormonal Effects
73
**Signs** Suggesting Ovarian Malignancy
74
**Signs** Suggesting Ovarian Malignancy
- Bilaterality
75
**Signs** Suggesting Ovarian Malignancy
- Solidity
76
**Signs** Suggesting Ovarian Malignancy
- Fixation
77
**Signs** Suggesting Ovarian Malignancy
- Presence of Ascites
78
**Signs** Suggesting Ovarian Malignancy
- Unilateral Edema or Varicosities
79
**Signs** Suggesting Ovarian Malignancy
- Presence of metastases
80
**Laparotomy Findings** Suggesting Ovarian Cancer
81
TTT of **Benigns Ovarian Tumors**
82
TTT of **Benigns Ovarian Tumors**
- Prophylactic
- By avoidance of predisposing factors e.g. avoid unnecessary induction of ovulation, removal of dysgenetic gonads at the age of puberty ....etc.
83
TTT of **Benigns Ovarian Tumors**
- Active
84
Active TTT of **Benigns Ovarian Tumors**
- Indications of Conservative Surgery
- Young patient "aiming to preserve fertility".
- Small cystic not complicated tumors.
- Suspicious or malignant tumor confined to 1 ovary when fertility is required.
85
Active TTT of **Benigns Ovarian Tumors**
- Lines of Conservative Surgery
- Cyst aspiration OR tapping in order to ll its size.
- Ovarian Cystectomy.
- Unilateral salpingo-ophorectomy.
- Laparoscopic surgery: cyst aspiration, de-roofing & removal.
86
Active TTT of **Benigns Ovarian Tumors**
- Indications of Radical Surgery
- Benign tumors old age > 45 years "not needing the ovaries for fear of malignancy".
- Recurrence after removal OR bilateral tumors.
87
Active TTT of **Benigns Ovarian Tumors**
- Lines of Radical Surgery
Total hysterectomy with bilateral salpingo-ophorectomy
88
TTT of **Malignant Ovarian Tumors**
????
