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Gynaecology > The ovary and its disorders > Flashcards

The ovary and its disorders Flashcards

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1
Q

Ovaries are attached to the broad ligament by

A

mesovarium

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2
Q

Ovaries are attached to the pelvic side wall by

A

infundibulopelvic ligament

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3
Q

Ovaries are attached to the uterus by

A

ovarian ligament

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4
Q

Blood supply to ovary is by

A

ovarian artery and uterine artery branch

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5
Q

Acute presentation of ovary pathology is often due to

A

ovarian cyst accidents

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6
Q

Ovarian intense pain- whats happened?

A

ruptured contents into peritoneal cavity- dermoid/endometrioma

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7
Q

Peritoneal cavity haemorrhage can lead to…

A

hypovolemic shock

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8
Q

How does PCOS present?

A

oligomenorrhoea, hirsutism, subfertility

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9
Q

Premature menopause is…

A

Last period before 40

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10
Q

Classification of ovarian tumours

A

Primary-epithelial, germ cell, sex cord. Secondary malignancies.

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11
Q

Most common malignant ovarian neoplasm

A

50% serous cystadenoma or adenocarcinoma

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12
Q

Epithelial tumours are formed from which layer in what age group

A

outermost epithelial layer, in post menopausal women

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13
Q

How do epitheliod ovarian tumours progress?

A

Borderline malignancy (no invasion) may progress to frank malignancy

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14
Q

Optimum management of ovarian epitheliod tumours is disputed. What would you do for a young woman with borderline cyst

A

Removal of just cyst to preserve fertility. Recurrence can occur upto 20 years.

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15
Q

What is a malignant epethelial tumour of the ovaries that can become large but less frequently malignant? What % prevalence?

A

10% Mucinous cystadenoma/adenocarcinoma.

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16
Q

What is a borderline variant of Mucinous cystadenoma- what happens in it?

A

Mucinous cystadenoma- pseudomyxoma peritonei- abdo cavity filled with gelatinous mucin secretions.

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17
Q

What is a malignant variant of epithelial ovarian tumour that is histologically similar to endometrial carcinoma? epidemiology.

A

Endometriod carcinoma, 25% ovarian cancers, 20% associated with EndoM Ca

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18
Q

Clear cell carcinomas of the ovary are…

A

malignant variant that accounts for <10% ovarian cancers but poor prognosis

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19
Q

Brenner tumours are…

A

Benign rare and small ovarian cancers

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20
Q

Where do germ cell tumours of the ovary arise?

A

Undifferentiated primordial germ cells of the gonad

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21
Q

Teratomas are

A

Common benign germ cell tumour sometimes with fully differentiated tissue of all cell lines like hair and teeth.

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22
Q

Teratomas present in/as

A

Young premenopausal women Bilateral, large and often asymptomatic. Rupture is painful.

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23
Q

Dysgerminoma presentation

A

Rare but most common ovarian malignancy in younger women

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24
Q

Dysgerminoma is the female equivalent of the

Study These Flashcards
A

Seminoma, germ cell tumour

25
Granulosa cell tumours are
Sex cord tumours
26
Sex cord tumours arise from the
Stroma of the gonad
27
Granulosa cell tumours most commonly found in
post menopausal women
28
Granulosa cell tumours
Usually malignant but slow growing and rare
29
Whats a good tumour marker for granulosa cell tumours?
Serum inhibin levels
30
Granulosa cell tumours secrete
high levels of oestrogens and inhibins which stimulate the endometrium causing- bleeding, endometrial hyperplasia-->malignancy and rarely precocious puberty
31
What are fibromas?
Rare and benign sex cord tumours of the ovary
32
What are thecomas and what do they secrete?
Rare benign sex cord ovarian tumours that produce oestrogens and androgens
33
What are 4 common premenopausal ovarian masses?
Follicular/lutein cysts Dermoid cysts Endometriomas Benign epithelial tumour
34
Fibromas cause a specific syndrome- name it and what happens?
Meigs' syndrome- ovarian mass + ascites + right pleural effusion
35
What are dermoid cyts?
Benign cystic teratoma that contains developmentally mature skin complete with hair follicles and sweat glands
36
What are the 2 post menopausal causes of ovarian masses?
Benign epithelial tumour | Malignancy
37
Two places that ovaries get mets from
GI and breast
38
What % of ovarian cancers are secondary
10%, poor prognosis
39
What are Krukenberg tumours
Secondary mets from gut- containing signet ring cells
40
What are endometriomas?
endometriotic cysts in ovaries, rupture is painful
41
What are endometriotic cysts?
Chocolate cysts- contain altered blood
42
What are the two types of functional cysts and which is more symptomatic?
Follicular cysts and lutein cysts- persistently enlarged follicles and corpus lutea. Lutein cysts are more symptomatic.
43
What is protective for functional cysts
COCP- inhibits ovulation
44
Who get functional cysts
premenopausal women
45
Treatment for functional cysts
None required with no symptoms- obeserved with serial ultrasounds. If >5cm persists beyond 2 months- CA125 is measured and laparoscopy considered to remove/drain the cyst.
46
3 risk factors and 3 protective factors for ovarian cancer and why
Early menarche, late menopause, nulliparity | Pregnancy lactation, COCP
47
Genetic component of ovarian cancer?
5% familial with BRCA1, 2 genes/ HNPCC
48
Does Ovarian cancer have screening?
Not yet, trial of 20000 women going on. TVS/CA125/Observation
49
What do you offer to women with a family history of ovarian cancer?
Couselling and genetic testing for BRCA. if positive- yearly tvs/ca125 or prophylactic BSO
50
What % of women present at stage 3/4?
70%
51
Which GI condition does Ovarian cancer present as and what are the symptoms?
IBS- Bloating, distention/mass, early satiety, loss of appetite, pelvic/abdominal pain, increased urgency or frequency.
52
What is the spread of ovarian adenocarcinoma called
transcoelomic spread
53
How do you stage ovarian cancer?
Stage 1 ovaries only a)1 b)both c)capsule not intact cells in cavity-ascites Stage 2 confined to pelvis Stage 3 confined to abdomen- omentum, small bowel peritoneum Stage 4 beyond abdomen- liver/lungs
54
How would you investigation a suspicion of ovarian cancer from IBS symptoms in old age?
CA125 level if >35IU/ml, US abdo-pelvis, mass or ascites= urgent secondary care referral. Under 40- AFP/hCG measured (germ cell tumours), calculate RMI. >250= specialist MDT team- CT abdo-pelvis, further stage by surgery
55
How is ovarian cancer managed?
Assess for fitness for surgery- esp elderly women and blood cross matched. Midline laparotomy- Total hysterectomy-BSO-partial omentectomy with biopsies of peritoneal deposits, peritoneum and retroperitoneal lymph nodes (stage 1). Remove all RPT if stage 2 through block dissection. Preserve functional ovary + uterus to preserve fertility but monitor meticulously Chemotherapy- Percutaneous image guided biopsy/laproscopy. High grade stage 1c- carpoplatin 6 cycles Stage 2-4- Carboplatin/cisplatin+/- paclitaxel
56
Only ovairan tumour that is radiotherapy sensitive.
Dysgerminomas.
57
How do you follow up ovarian cancer post treatment?
CA125 levels, CT scan- residual disease/relapse. Interval debulking. Chemo=short term + QALY
58
Most common reason for death by ovarian cancer.
Bowel obstruction or perforation
59
What specific end of life problems with ovarian cancer that need palliation
Heavy vaginal bleeding, Ascites(paracentesis) and bowel obstruction (metoclopramide)

Gynaecology (11 decks)

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