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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?
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?
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
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?
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?
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?
: have thin serous fluid, unilocular cavity
: 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?
have transitional epithelium
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?
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
: teeth and hair
what ares symptoms of dermoid cyst?
when are dermoid cysts very painful?
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?
: 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
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
feel a mass
breast/GI symptoms due to mets or HNPCC/BRCA
pressure effects - constipation
what do you do for examination in suspected ovarian cancer?
: distension, feel mass, ascites (shifting dullness)
: adnexal mass/tenderness
how can you tell if an ovarian mass is malignant? think about US
rapid growth >5cm
solid or separate nature on US
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?
: solid/separate, ascites, vascular
paracentesis of ascites - malignant cells
what is Rx for all ovarian cancer? who not?
: TAH BSO omentecomy - staging at laparotomy
aim to debulk - help palliative to
not if young + want children
: 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?
: analgesic ladder
heavy vaginal bleeding
: high dose progestagens
: metoclopramide (enhance motility), stool softener, enema
which is the only ovarian tumour does the COCP not protect you against?
what is a krukenberg tumour?
secondary tumour in the ovary from a GI - particularly stomach
get haematemesis and bilateral ovarian swellings