which age group are malignant ovarian tumours more common in?
which 2 occasions can ovarian masses be detected on?
what are the 3 types of physiological ovarian cysts?
- theca lutein
which age group do you get physiological cysts?
- as related to ovulation
what protects from physiological cysts?
COCP as protects from ovulation
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)
what causes a raised CA125?
- ovarian cancer
- its an epithelial tumour marker
why do you get follicular cysts?
- non rupture of dominant follicle
- or failure of atresia of non dominant follicle
which type of cysts are more likely to present with INTRAPERITONEAL BLEEDING?
- corpus luteal cyst
- rupture d20-26
when do you get theca lutein cysts? appearance?
- with pregnancy including molar pregnancies
- multicystic (regress spont)
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
what are most common causes of ruptured ovarian cyst?
- dermoid cyst
what are symptoms of ovarian torsion?
- sudden onset, severe, unilateral lower abode pain
- worsens over hours
- fever = late if ovary becomes necrotic!
- onset during exercise or other agitating movement is common
what are causes of ovarian torsion?
- pregnancy - due to ovarian enlargement in ovulation
- ovarian tumours - esp dermoid
- past pelvic surgery
what are the 3 main types of primary tumours (B/M) in ovary?
- epithelial tumour
- germ cell tumour
- sex cord tumour
which age group are epithelial tumours most common in?
post menopausal women
which type of epithelial tumour is the most common cause of ovarian caner?
how do you compare serous with mutinous cystadenomas?
- serous: have thin serous fluid, unilocular cavity
- mucinous: thick mucoid fluid, multilocular. can become very large
which ovarian cancer has a particularly poor prognosis?
clear cell carcinoma
which carcinoma accounts for 25% of ovarian malignancies?
what cell line do brannier tumours come from?
- uroepithelial cells
- have transitional epithelium
- small, rare
which cells do germ cell tumours arise from?
undifferentiated primordial germ cells of the gonad
what are the 2 types of germ cell tumours in ovaries?
- teratoma/dermoid cyst
- dysgerminoma (female equiv of seminoma)
which is the most common ovarian cancer in younger women?
what type of Rx are dysgerminomas sensitive to?
what is the other name for teratoma?
which age group get dermoid cysts?
young pre-menopausal women
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
what ares symptoms of dermoid cyst?
when are dermoid cysts very painful?
- when rupture
- can also go into torsion as heavy
what % of dermoid cysts are bilaterall?
what is the malignant form of a dermoid cyst called?
where do sex cord tumours arise from?
STROMA of the gonad
what type of symptoms do sex cord tumours give and why?
hormonally mediated symptoms as they can secrete hormones
what are the 3 main types of sex cord tumours?
- granulosa cell tumours
which age group are granulosa cell tumours found in?
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
which 2 hormones does granulosa cell tumours secrete?
what is used as a tumour marker for granulosa cell tumours?
what can thecomas secrete
- (very rare tumours)
- nearly always benign (whereas granulosa cell tumours are malignant)
why may you get PMB in thecoma?
as it secretes oestrogen
what is Meig's syndrome?
- right pleural effusion - cured by removal of ovarian mass
- small ovarian mass - fibroma usually
if suspect ovarian cyst, what 2 Ix do you do?
what is the most common gynae malignancy?
what are the RF for ovarian cancer?
- relate to number of ovulations
- early menarche
- late menopause
- late age at first conception
- BRCA1/2 gene (mutation at chr 13/17)
- HNPCC = Lynch II (breast, endometrial, colon, ovarian)
what are protective factors for ovarian cancer?
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
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
how can you tell if an ovarian mass is malignant? think about US
- rapid growth >5cm
- older age
- bilateral masses
- solid or separate nature on US
- increased vascularity
what is stage 1-4 of ovarian cancer?
- 1 - ovaries
- 2 - pelvis
- 3 - abdomen
- 4 - distant eg liver, lung
how does ovarian adenocarcinoma spread usually?
transcoelomic spread - ie directly within the pelvis and abdomen
which Ix do you do in suspect ovarian cancer?
- US: solid/separate, ascites, vascular
- paracentesis of ascites - malignant cells
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
what Rx for those who need to preserve fertility?
- laparoscopy and oophrectomy if low stage
- need close monitoring
which ovarian tumour do you treat with radiotherapy?
which ovarian cancer has worst prognosis?
clear cell carcinoma
what usually causes death in ovarian cancer?
bowel obstruction or perforation
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