Ovary and problems

Question 1

Name 2 ovarian causes of acute pain. (2)

Answer 1

Ovarian torsion
Rupture of ovarian cyst
Haemorrhage into ovarian cyst.

Question 2

What is PCOS? (2)

Answer 2

Polycystic ovary syndrome is characterised by multiple, small poorly developed follicles on ovary surface.
Causing triad of hirsutism, oligomenorrhoea and subferility.

Question 3

What is oligomenorrhoea? (1)

Answer 3

Infrequent periods. Cycles lasting over 35 days up to 6 months.

Question 4

What are the three main types of primary ovarian tumours? (3)

Answer 4

Epithelial: serous adenocarcinoma**, mucoid carcinoma, clear cell carcinoma
Germ cell: teratoma or dermoid cyst (benign)
Sex cord: granulosa cell tumours

Question 5

What is Meig’s syndrome? (3)

Answer 5

Ascites, R pleural effusion and small ovarian mass.

Question 6

Name 2 causes of secondary ovarian tumours. (2)

Answer 6

Breast cancer, bowel cancer.

Question 7

Yves has an ovarian cancer.
What is the oat likely type if she is …
a) 65 years old
b) 27 years old (2)

Answer 7

a) epithelial (serous adenocarcinoma)

b) germ cell (dysgerminoma)

Question 8

What are the risk factors for developing cancer of the ovary? (2)

Answer 8

Increased number of ovulations.

• early menarche
• late menopause
• nulliparity
• family history

Question 9

Name 2 protective factors against developing ovarian carcinoma. (2)

Answer 9

COC
Multiparity
Breastfeeding
Hysterectomy

Question 10

How does ovarian cancer present? (2)

Answer 10

Often silent in early stages, so tends to present late with abdominal distension or mass, pain or vaginal bleeding.

Question 11

What tumour markers may indicate ovarian cancer? (3)

Answer 11

Ca-125 in epithelial cancer

AFP and b-HcG in younger for germ cell tumours.

Question 12

Joy is a 67 year old lady presenting with various abdominal symptoms; bloating, early satiety and increased urinary frequency.
You feel it is important to exclude a diagnosis of ovarian cancer before diagnosing IBS.
What is you next step? (2)

Answer 12

Ca 125 levels if over 50y.
If raised then USS of abdomen and pelvis.
(also check breasts and ask about bowel symptom due to risk of metastases from these sites)

Determine risk of malignancy index (RMI) using;
ultrasound score x menopausal status x Ca-125

Question 13

What is the management for ovarian carcinoma? (3)

Answer 13

Staging laparotomy: total abdominal hysterectomy and BSO; partial omentectomy, peritoneal biopsies, assessment of pelvic lymph nodes
Advanced: debunking procedure (TAH/BSO, omentectomy, resection of mets)
Chemo: platinum compounds and taxanes.
Radiotherapy: mainly for palliation.