Ovarian problems.txt

  1. which age group are malignant ovarian tumours more common in?
    post menopausal
  2. which 2 occasions can ovarian masses be detected on?
    • abdo distension
    • USS
  3. what are the 3 types of physiological ovarian cysts?
    • follicular
    • luteal
    • theca lutein
  4. which age group do you get physiological cysts?
    • pre-menopausal
    • as related to ovulation
  5. what protects from physiological cysts?
    COCP as protects from ovulation
  6. what is Rx for most physiological/fiunctional cysts?
    • no treatment unless symptoms
    • if cyst>5cm and persists beyond 2 months then do CA125 (CA=carcinoma antigen - its an epithelial tumour marker)
  7. what causes a raised CA125?
    • ovarian cancer
    • fibroids
    • pregnancy
    • its an epithelial tumour marker
  8. why do you get follicular cysts?
    • non rupture of dominant follicle
    • or failure of atresia of non dominant follicle
  9. which type of cysts are more likely to present with INTRAPERITONEAL BLEEDING?
    • corpus luteal cyst
    • rupture d20-26
  10. when do you get theca lutein cysts? appearance?
    • with pregnancy including molar pregnancies
    • multicystic (regress spont)
  11. what are symptoms of ruptured ovarian cyst?
    • intense pain - especially if endometrioma or dermoid cyst
    • hypovolaemic shock due to peritoneal haemorrhage - rare as minimal bld loss usually
    • pain may resolve after few hours as ruptured
  12. what are most common causes of ruptured ovarian cyst?
    • dermoid cyst
    • cystadenoma
    • endometrioma
  13. what are symptoms of ovarian torsion?
    • sudden onset, severe, unilateral lower abode pain
    • worsens over hours
    • N&V
    • fever = late if ovary becomes necrotic!
    • onset during exercise or other agitating movement is common
  14. what are causes of ovarian torsion?
    • pregnancy - due to ovarian enlargement in ovulation
    • ovarian tumours - esp dermoid
    • past pelvic surgery
  15. what are the 3 main types of primary tumours (B/M) in ovary?
    • epithelial tumour
    • germ cell tumour
    • sex cord tumour
  16. which age group are epithelial tumours most common in?
    post menopausal women
  17. which type of epithelial tumour is the most common cause of ovarian caner?
    serous adenocarcinoma
  18. how do you compare serous with mutinous cystadenomas?
    • serous: have thin serous fluid, unilocular cavity
    • mucinous: thick mucoid fluid, multilocular. can become very large
  19. which ovarian cancer has a particularly poor prognosis?
    clear cell carcinoma
  20. which carcinoma accounts for 25% of ovarian malignancies?
    endometrioid carcinoma
  21. what cell line do brannier tumours come from?
    • uroepithelial cells
    • have transitional epithelium
    • small, rare
  22. which cells do germ cell tumours arise from?
    undifferentiated primordial germ cells of the gonad
  23. what are the 2 types of germ cell tumours in ovaries?
    • teratoma/dermoid cyst
    • dysgerminoma (female equiv of seminoma)
  24. which is the most common ovarian cancer in younger women?
  25. what type of Rx are dysgerminomas sensitive to?
  26. what is the other name for teratoma?
    dermoid cyst
  27. which age group get dermoid cysts?
    young pre-menopausal women
  28. what do dermoid cysts contain?
    • can contain fully differentiated tissue of all cell lines - hair and teeth
    • ectoderm: teeth and hair
    • endoderm: intestine
    • mesoderm: bone
  29. what ares symptoms of dermoid cyst?
    usually asymptomatic
  30. when are dermoid cysts very painful?
    • when rupture
    • can also go into torsion as heavy
  31. what % of dermoid cysts are bilaterall?
  32. what is the malignant form of a dermoid cyst called?
    • solid teratoma
    • rare
  33. where do sex cord tumours arise from?
    STROMA of the gonad
  34. what type of symptoms do sex cord tumours give and why?
    hormonally mediated symptoms as they can secrete hormones
  35. what are the 3 main types of sex cord tumours?
    • granulosa cell tumours
    • thecomas
    • fibromas
  36. which age group are granulosa cell tumours found in?
    post menopausal
  37. what symptoms can granulosa cell tumours give - 2 and why?
    • bleeding: as they secrete oestrogen which stimulates endometrium and cause bleeding
    • oestrogen also causes endometrial hyperplasia and cancer
    • precocious puberty in young girls as lots of oestrogen
  38. which 2 hormones does granulosa cell tumours secrete?
    • inhibin
    • oestrogen
  39. what is used as a tumour marker for granulosa cell tumours?
    inhibin levels
  40. what can thecomas secrete
    • oestrogens
    • androgens
    • (very rare tumours)
    • nearly always benign (whereas granulosa cell tumours are malignant)
  41. why may you get PMB in thecoma?
    as it secretes oestrogen
  42. what is Meig's syndrome?
    • ascites
    • right pleural effusion - cured by removal of ovarian mass
    • small ovarian mass - fibroma usually
  43. if suspect ovarian cyst, what 2 Ix do you do?
    • CA125
    • USS
  44. what is the most common gynae malignancy?
    ovarian cancer
  45. what are the RF for ovarian cancer?
    • relate to number of ovulations
    • early menarche
    • late menopause
    • nulliparity
    • late age at first conception
    • HRT
    • FH
    • BRCA1/2 gene (mutation at chr 13/17)
    • HNPCC = Lynch II (breast, endometrial, colon, ovarian)
  46. what are protective factors for ovarian cancer?
    • pregnancy
    • lactation
    • COCP
  47. what are symptoms of ovarian cancer?
    • usually silent until stage 3-4
    • abdominal distension
    • feel a mass
    • pain uncommon
    • vaginal bleeding
    • breast/GI symptoms due to mets or HNPCC/BRCA
    • pressure effects - constipation
  48. what do you do for examination in suspected ovarian cancer?
    • abode exam: distension, feel mass, ascites (shifting dullness)
    • bimanual palpation: adnexal mass/tenderness
    • palpate breasts
  49. how can you tell if an ovarian mass is malignant? think about US
    • rapid growth >5cm
    • ascites
    • older age
    • bilateral masses
    • solid or separate nature on US
    • increased vascularity
  50. what is stage 1-4 of ovarian cancer?
    • 1 - ovaries
    • 2 - pelvis
    • 3 - abdomen
    • 4 - distant eg liver, lung
  51. how does ovarian adenocarcinoma spread usually?
    transcoelomic spread - ie directly within the pelvis and abdomen
  52. which Ix do you do in suspect ovarian cancer?
    • US: solid/separate, ascites, vascular
    • laparoscopy
    • CA125
    • LFT
    • CXR
    • paracentesis of ascites - malignant cells
  53. what is Rx for all ovarian cancer? who not?
    • surgery: TAH BSO omentecomy - staging at laparotomy
    • aim to debulk - help palliative to
    • not if young + want children
    • chemo: carboplatin / taxol unless v.low risk
  54. what Rx for those who need to preserve fertility?
    • laparoscopy and oophrectomy if low stage
    • need close monitoring
  55. which ovarian tumour do you treat with radiotherapy?
  56. which ovarian cancer has worst prognosis?
    clear cell carcinoma
  57. what usually causes death in ovarian cancer?
    bowel obstruction or perforation
  58. what palliative measures need to be taken into consideration with ovarian cancer?
    • pain: analgesic ladder
    • N&V: ondansetron
    • heavy vaginal bleeding: high dose progestagens
    • ascites: paracentesis
    • bowel obstruciton: metoclopramide (enhance motility), stool softener, enema
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Ovarian problems.txt