Ovarian cysts Flashcards
(22 cards)
What are cysts?
Fluid filled sac
What are functional ovarian cysts?
Cysts related to fluctuating hormones of menstrual cycle and are very common in premenopausal women - usually benign
When are cysts concerning?
In post menopausal women in case of malignancy
How do cysts present?
Normally asymptomatic and picked up incidentally on pelvic USS. May cause vague symptoms of: pelvic pain, bloating, fullness in abdomen and a palpable pelvic mass
When would you get acute pelvic pain?
If there is ovarian torsion, haemorrhage or rupture
What are follicular cysts?
Represent the developing follicle. Where a developing follicle fails to rupture and release the egg, the cyst can persist. They are harmless and disappear after a few menstrual cycles
How do functional cysts appear on an USS?
They have thin walls and no internal structures so look reassuring on an USS
What are corpus luteum cysts and when are they often seen?
Occur when corpus luteum fails to break down and fills with fluid - may cause pelvic discomfort, pain or delayed menstruation. Often seen in early pregnancy
What are serous cystadenomas?
Benign tumours of epithelial cells
What are mucinous cystadenomas?
Benign tumours of epithelial cells but can become huge, taking up lots of space in pelvis & abdomen
What are dermoid cysts/germ cell tumours?
Benign ovarian tumours which are teratomas so come from germ cells and contain various tissue types like skin, teeth, hair and bone - they are particularly associated with ovarian torsion
What are sex cord stromal tumours?
Rare tumours which can be benign or malignant - arise from stroma or sex cords and have several types
What features suggest malignancy?
Abnormal bloating & reduced appetite, early satiety & weight loss, urinary symptoms, pain & ascites, lymphadenopathy
What are risk factors for ovarian malignancy?
Age, Postmenopause, increased number of ovulations, obesity, HRT, smoking, FH of BRCA1 and BRCA2
When do you not investigate further?
Premenopausal women with a simple ovarian cyst less than 5cm on USS
What is the tumour marker for ovarian tumours?
CA-125 but this can also be raised in endometriosis, adenomyosis & fibroids, pelvic infection, liver disease, pregnancy
What are markers for possible germ cell tumour?
Lactate dehydrogenase, Alpha-fetoprotein, HCG
What is the risk of malignancy index?
Estimates the risk of an ovarian mass being malignant, taking account: Menopausal status, USS findings, CA125 level
How do you manage simple ovarian cysts?
Less than 5cm → resolves within 3 cycles, no follow up scan. 5cm-7cm → routine referral to gynae and yearly USS monitoring. More than 7cm → consider MRI or surgical evaluation
What surgical intervention may be necessary?
Ovarian cystectomy - removing the cyst potentially with affected ovary - oophorectomy
What are the main complications?
Torsion, haemorrhage into cyst, rupture - with bleeding into peritoneum
What is Meigs syndrome?
Triad of: ovarian fibroma (benign ovarian tumour), pleural effusion, ascites. Typically occurs in older women & tumour removal results in complete resolution of effusion & ascites
