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which age group are malignant ovarian tumours more common in?
post menopausal
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which 2 occasions can ovarian masses be detected on?
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what are the 3 types of physiological ovarian cysts?
- follicular
- luteal
- theca lutein
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which age group do you get physiological cysts?
- pre-menopausal
- as related to ovulation
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what protects from physiological cysts?
COCP as protects from ovulation
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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)
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what causes a raised CA125?
- ovarian cancer
- fibroids
- pregnancy
- its an epithelial tumour marker
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why do you get follicular cysts?
- non rupture of dominant follicle
- or failure of atresia of non dominant follicle
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which type of cysts are more likely to present with INTRAPERITONEAL BLEEDING?
- corpus luteal cyst
- rupture d20-26
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when do you get theca lutein cysts? appearance?
- with pregnancy including molar pregnancies
- multicystic (regress spont)
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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
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what are most common causes of ruptured ovarian cyst?
- dermoid cyst
- cystadenoma
- endometrioma
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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
-
what are causes of ovarian torsion?
- pregnancy - due to ovarian enlargement in ovulation
- ovarian tumours - esp dermoid
- past pelvic surgery
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what are the 3 main types of primary tumours (B/M) in ovary?
- epithelial tumour
- germ cell tumour
- sex cord tumour
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which age group are epithelial tumours most common in?
post menopausal women
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which type of epithelial tumour is the most common cause of ovarian caner?
serous adenocarcinoma
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how do you compare serous with mutinous cystadenomas?
- serous: have thin serous fluid, unilocular cavity
- mucinous: thick mucoid fluid, multilocular. can become very large
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which ovarian cancer has a particularly poor prognosis?
clear cell carcinoma
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which carcinoma accounts for 25% of ovarian malignancies?
endometrioid carcinoma
-
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
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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?
dysgerminoma
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what type of Rx are dysgerminomas sensitive to?
radiotherapy
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what is the other name for teratoma?
dermoid cyst
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which age group get dermoid cysts?
young pre-menopausal women
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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
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what ares symptoms of dermoid cyst?
usually asymptomatic
-
when are dermoid cysts very painful?
- when rupture
- can also go into torsion as heavy
-
what % of dermoid cysts are bilaterall?
10%
-
what is the malignant form of a dermoid cyst called?
-
where do sex cord tumours arise from?
STROMA of the gonad
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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
- thecomas
- fibromas
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which age group are granulosa cell tumours found in?
post menopausal
-
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
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which 2 hormones does granulosa cell tumours secrete?
-
what is used as a tumour marker for granulosa cell tumours?
inhibin levels
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what can thecomas secrete
- oestrogens
- androgens
- (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?
- ascites
- right pleural effusion - cured by removal of ovarian mass
- small ovarian mass - fibroma usually
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if suspect ovarian cyst, what 2 Ix do you do?
-
what is the most common gynae malignancy?
ovarian cancer
-
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)
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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
- ascites
- 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
- laparoscopy
- CA125
- LFT
- CXR
- paracentesis of ascites - malignant cells
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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
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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?
dysgerminoma
-
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
-
which is the only ovarian tumour does the COCP not protect you against?
teratoma!
-
what is a krukenberg tumour?
- secondary tumour in the ovary from a GI - particularly stomach
- get haematemesis and bilateral ovarian swellings
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