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22 Cards in this Set
- Front
- Back
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What non-neoplastic ovarian tumours exist? |
Functional cysts Non-functional cysts |
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What are the types of functional cysts? |
Follicularcysts: follicle -> no ovulation -> persistent GnRH stimulation -> cystformation
Corpusluteum cysts: follicle -> ovulation -> persisting Progesterone producingcyst -> eventual involution Thesecysts are confined to the reproductive years and to those not using hormonalc/c |
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How does a functional cyst present? |
Can be asymptomatic / pain / menstrualirregularity
Ca125 usually <35 |
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What are the ultrasound criteria for functional cysts? |
Unilocular
Thin walled Smooth walls Echo free contents Unilateral Usually <8cm in diameter |
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How do we treat functional cysts? |
Mostwill undergo regression with menstruation
–Can wait (not if pain is a problem) –Hormonal suppresion of GnRH stimulation: OC best and convenient, or Provera 5mg 2x per day for 10 days(progesterone treatment), + NSAIDs for pain, And reassess after menstruation |
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What are the complications of a cysts? |
Torsion
–Mechanism –clinical: acute pain, nausea, faint –Tenderness, mass, acute abdomen –Diff dx: Ectopic pregnancy –Ultrasound, Hb, hCG –Treatment: laparotomy + adnexectomy Bleeding Rupture |
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What are the types of non-functional cyst? |
Endometriomas
Theca-lutein cysts Par-ovarian cysts Residual ovarian syndrome - post-hysterectomy - pain and dyspareunia - ovary stuck to the vault. - Surgicalmanagement: removal or suspension |
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What are the types of neoplastic ovarian tumours? |
Epithelial
Stromal Germcell Metastatic Behaviour: –Benign/ borderline malignancy / malignant |
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What is the significance of ovarian cancer? |
Uncommon but very important: Gynaecologiccancer with poorest prognosis
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What are the causes of ovarian cancer? |
Probably genetic |
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What are the risk factors for ovarian cancer? |
Age 40-65y
Ownor family history of breast / ovary / endometrium / colon cancer Neverpregnant / infertility / low parity |
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What decreases the risk for Ovarian cancer? |
Oral Contraceptives
Oophorectomy with strong familyhistory |
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What is the screening for ovarian cancer? |
poor tests available
CA125 and ultrasound used: low pick up and predictability |
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What is the clinical picture of ovarian cancer? |
History:few complaints, non specific: tired, pain, urinary and GIT complaints,abdominal distension, only 1% bleeds
Examination: ascites, mass in abdomen andpelvis, solid, bilateral, tender |
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What tests are used in diagnosing ovarian cancer? |
CA125: useful as marker if patient has raised value
FBC,sedimentation, U&E, LFT, CXR, ultrasound Bowel:diff dx: Ba enema / colonoscopy / occult blood |
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What are the ultrasound criteria for potentially malignant tumours? |
Solid / semicystic
Multilocular Thick walled Papillary growths on walls of cysts andtumour Bilateral Ascites |
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How is ovarian cancer staged? |
Surgical, also 1-4 system
Stage I: confined to ovary / ovaries (15%) Stage II: also uterus, tubes, bladder andrectal walls, pelvic peritoneum (10%) Stage III: upper abdomen, peritoneum, omentum,lymph nodes (60%) Stage IV: lungs, liver, other organs (15%) |
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How is ovarian cancer treated? |
Principle:Surgery followed by chemotherapy
Operations: –Staginglaparotomy:for confined disease: TAH BSO omentectomy, nodes and ascites –Cytoreduction: forintraperitoneal spread: aim to do same and not leave tumour larger than 1cmbehind –Intervalcytoreduction:apparently inoperable: biopsy and chemo X 3, then surgery Chemotherapy: for stages 1c onwards: 6 courses |
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What is the prognosis of ovarian cancer? |
5 years survival: Stage I: 90%,Stage II 40%, Stage III 30%, Stage IV 10% Causes of death –Intestinalobstruction, metastases, cachexia –Needspain control and care, nutritional support and ascites control |
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What are the histological types of ovarian cancer? |
Epithelial
–Serous, mucinous, endometroid, clearcell, mixed Stromal –Granulosa, theca, G+T, sertoli, leydigS+L, mixed, lipoid Germcell –Dysgerminoma, yolk sac, embryonal, mixed –Benign cystic teratoma |
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What are the group characteristics of ovarian tumours? |
Epithelial: “common”,45-65y, imitates other mullerian epithelia: serous, mucinous, endometroid,clear cell. Can be Benign, borderline malignant or malignant
Stromal: rare,any age, low grade malignant behaviour; hormone producing: E: G, T. A: S, LGermcell: veryrare; children and adolescents, highly malignant, unilateral. Chemosensitive |
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What is the exception to the group characteristics of ovarian tumours? |
Benign Cystic Teratoma Mostcommon ovarian tumour of children and young adults. Usually unilateral, fewsymptoms: pain, torsion, bleeding. Containstissue from all 3 embryonic layers Onsection: hair, sebaceous material, bone and teeth Rx:ovarian cystectomy with conservation of normal ovarian tissue |
