Ovarian Tumours

Question 1

Tumor marker CA125 increased in:

Answer 1

90% of epithelial tumours

Question 2

Tumour marker HCG increased in:

Answer 2

Choriocarcinoma

Question 3

Alpha-feto protein increased in:

Answer 3

Endodermal sinus tumours

Question 4

carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 increased in:

Answer 4

Mucinous tumours

Question 5

Lactate dehydrogenase increased in:

Answer 5

Dysgerminoma

Question 6

Functional non neoplastic tumors:

Answer 6

Follicular cyst : <3cm
Luteal cyst:
1. Corpus luteal cyst: hge into cyst
2. Theca luteal cyst: +HCG, a/w hydatidiform mole, chorioca-clomid or gonadotropine therapy

Question 7

Pathological non-neoplastic tumors:

Answer 7

Ovarian Endometriotic cyst
PCOS

Question 8

Benign tumors:

Answer 8

Epithelial tumors
Benign germ cells tumors
Sex cord stromal tumors

Question 9

Benign Epithelial tumors

Answer 9

Serous cyst adenoma
Mucinous cyst adenoma
Brenner tumor

Question 10

Benign germ cells

Answer 10

Mature teratoma or dermoid cyst

Question 11

Benign sex cord stromal tumors;

Answer 11

Fibroma
Sertoli-leydig cell
Thecoma
Lipoma

Question 12

Neoplastic tumors:
Surface epithelium

Answer 12

Serous cyst adenoma : CA125
Mucinous cyst adenoma: CEA&C19, 9
Clear cell tumor: worst prog, hobnail cells
Endometrioid: a/w EC
Brenner: most are benign

Question 13

Germ cell tumors embryonic

Answer 13

1. Teratoma: adolsencenc, unilateral symptomless unless ruptured
2. Dysgerminoma (common form of malignancy in germ cells): phenotypic femal, bilateral, radiosensitive (good prog) ++LDH
3. Extra embryonic: Endodermal sinus tumor: secrete AFP and non-gestational chorio carcinoma secrete HCG
   4.Gonado plastima
4. 2ry tumors from metastasis (krukenberg) : bilateral? Signal ring cells

Question 14

Sex cord tumors(stromal tumors):

Answer 14

Granulosa &theca cell tumor
Sertoli-leydig cells (androblastoma or arrhenoblastima)
Gynandroblastoma
Fibroma

Question 15

It may produces estrogen, cause precocious puberty and postmenopausal bleeding

Answer 15

Granulosa & theca cell tumor

Question 16

It secrets androgen musculining tumour amd causes virilisarion

Answer 16

Sertoli-leydig cells

Question 17

It secretes androgen at its sex cord tumor and contains male and female cell type

Answer 17

Gynandroblastoma

Question 18

Lobulated bilateral, it causes Meig’s syndrome (ascitis+hydrothorax)it is a non-secreting tumor

Answer 18

Fibroma

Question 19

Clinical presentation:

Answer 19

Usually asymptomatic unless if rupture or torsion causes pain
Abdominal fullness
Irregular P/V bleeding-loss of weight
urinary symptoms if press bladder
precocious puberty if secreting estrogen

Question 20

On examination :

Answer 20

–weight
Respiratory exam (Pleural effusion? Ascitis, mass)

Question 21

PV Bimanual examination

Answer 21

Pulge mass> solid or soft regular or iiregular if cystic if fixed or not & if there is nodular suggesting endometriosis

Question 22

D/D

Answer 22

Pregnancy
Ascitis
Bladder
Ectopic pregnancy
Hydronephrosis
Pelvic kidney
Fibroid
Tubo ovarian abscess

Question 23

Investigations

Answer 23

Tumor markers:
CA125 ++ in 90% of epith. Tumor
CEA, CA19-9 + in mucinous tumor
AFP + in endometrial sinus tumors
LDH> in dysgerminoma

Question 24

Other investigation

Answer 24

CBP: U&E , LFT, especially Albumin
USS
Doppler; for tumor that may show ++ vascularity
MRI & CT
IV Pyelography : suspect renal involvement
Barium enema if rectal involvement

Question 25

Treatment of benign:

Answer 25

**Cystectomy**: wish to preserve fertility **Ovarectomy** : if large tumor **Hyst.BSO**: if her family completed

Question 26

Treatment of malignancy:

Answer 26

staging laparatomy through mid line incision: Hyst BSO Omentectomy Lymph node sampling Pertoneal biopsies -Scrubbing of diaphram Pelvic washing or ascitis sampling

Question 27

**Treatment of malignancy** If tumor is advanced:

Answer 27

Debulking or cytoreductive surgery: The aim is to remove as much tumor as possible

Question 28

**Treatment of malignancy** Germ cell tumor confined to single ovary

Answer 28

**Unilateral slpingeo-oophorectomy** & preserve contralateral ovary, and it may need **chemotherapy**

Question 29

Chemotherapy

Answer 29

Ised after surgery

Question 30

Examples of chemotherapy that used in ovarian tumours with S/E

Answer 30

**Platinum**: Cisplatinum: nephrotoxic, neurotoxicity peripheral neuropathy auto toxicity Carboplatin: thrombocytopenia &leukopenia **Taxol**: Paclitaxel: hypersensitivity reaction, mucositis-neutropenia-alopecia, BM- depression, arrhythmia and heart attack