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70 Cards in this Set

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  • Back
at what ages are most malignant ovarian tumors found?
prepubescent or postmenopausal - <15 and after menopause (most are in post-menopausal)
___% of ovarian masses in a woman >50 are malignant.
Why are intra-abdominal neoplasias difficult to diagnose and treat?
no precursors, no high risk population, no real screening tools, no great improvements on survival rates even with better XRT and chemo, DIFFICULT TO DIAGNOSE
You should or should not be able to palpate a post menopausal ovaries?
should NOT - lack of stimulation causes them to atrophy
an ovarian mass in a postmenopausal woman should be considered _____ until proven otherwise.
____ cancer is a leading cause of death in women.
What is a woman's lifetime % risk of getting ovarian cancer?
When eliciting a good history, the patient tells you she has missed a period, what do you think of?
ectopic or intrauterine pregnancy
When eliciting a good history, the patient tells you she has menorrhagia/dysmenorrhea, what do you think of?
When eliciting a good history, the patient tells you she has pain immediately after intercourse, what do you think of?
ruptured cyst
When eliciting a good history, the patient tells you she has mid-cycle pain?
physiologic cyst: follicular or corpus luteum
When eliciting a good history, the patient tells you she has dysmenorrhea/dyspareunia, what do you think of?
When eliciting a good history, the patient tells you she has abrupt pain with nausea and vomitting, think of?
torsion, perforation, infarction, hemorrhage, degenerating fibroid
When eliciting a good history, the patient tells you she has pain with fever, what do you think of?
PID, tubo-ovarian abscess, appendicitis, diverticulitis, degenerating fibroid
When eliciting a good history, the patient tells you she has chronic abdominal bloating, what do you think of?
ovarian cancer
When eliciting a good history, the 64 yo patient tells you she is having periods again, what do you think of?
endometrial or fallopian tube cancer
When eliciting a good history, the patient tells you she has abnormal uterine bleeding, breast tenderness, hirsutism, sexual precocity, what do you think of?
sex cord or germ cell tumor
when doing a PE you palpate the adnexa and the patient flinches with pain, what do you think of?
inflammatory tubo-ovarian abscess
when doing a PE you palpate the adnexa feel enlarged mobile irregular uterus, what do think of?
when doing a PE you palpate the adnexa and feel cul-de-sac nodularity, think of?
Name the different laboratory test you can do on a female.
Serum, Urine, Micro cultures, PAP/HPV, Tumor markers, Wet Mount, Schiller Test, One Swab for most all STDs, HCG pregnancy test.
Name the tumor marker that indicates a surface-derived epithelial ovarian tumor.
CA-125 -> account for 60-70% of ovarian tumors
what would be considered an elevated Ca-125 and what else, besides ovarian cancer does it pick up?
>35U/ml is elevated; CA-125 is also elevated in endometriosis, PID, fibroids, etc
Name the tumor marker that indicates the germ cell tumor, dysgerminoma.
If a female isn't pregnant but has high HCG, what type of tumor do you suspect?
what is the difference in sensitivity and specificity?
sensitivity = the probability that if the person has the disease, the test will be positive; a 100% sensitive test means that the test recognizes all sick people as having the disease; SPECIFICITY = tests the negatives, the proportions of true negatives really test negative (low false-positive rate).
Of all the diagnostic modalities, which is the most valuable in evaluating adnexal masses?
ultrasound - great for looking at cystic vs. solid
Which is more concerning? Cystic or Solid mass?
Solid mass is much worse - do a complete workup very soon
List the characteristics of a benign mass.
anechoic, fluid filled cyst; thin-walled; homogenous low to medium echoes in a thick-walled cyst suggest endometrioma
List the characteristics of a malignant mass.
solid, nodular or papillary, thick septations, increased color/doppler flow, presence of ascites, peritoneal mass, enlarged nodes, matted bowel, thick walled with papillary excresenses(abnormal, excessive, or useless outgrowth)
name some features that are associated with an increased risk of malignancy in an ovarian neoplasm.
1) personal hx of breast or colon CA; 2)strong family hx of ovarian, breast, colonic, or endometrial CA; 3) Positive CA-125; 4) suspcious findings on US; 5) suspicious findings on PE
Name the 3 types of Ultrasound.
Transabdominal, Transvaginal, Doppler (shows blood flow, which is increased in CA)
What imaging modality is good for visualizing the adnexa esp. in an obese female?
transvaginal ultrasound - no bladder distention required (vs. transabdominal), less artifact, better visualization of pelvic structures
What is the normal size of a premenopausal ovary?
3.5x2x1.5cm - size doesn't correlate with malignancy
What do multiple small cysts suggest?
Of the following scopes, list what body part they associate with: colposcopy, hysteroscopy, laporoscopy.
Colposcopy: cervix; Hysteroscopy: Uterus; Laporscopy: abdominal cavity
What are the deciding factors on the plan to intervene or not in an adnexal mass?
the decision is based on: age, findings on pelvic/US, Labs, and Symptoms
What are the major issues with intervening?
risk of: malignancy, rupture, torsion, surgery complications, future fertility, possibly increasing the amount of pain, early-onset menopause
If you find a simple cyst that is <10cm what would you do and why?
put pt on oral contraceptives and follow since 70% of simple cysts will resolve over several cycles
If you find a cyst >10cm, what would you do?
surgical exploration and consult a gynecological oncologist
If the female is pregnant and you find a cyst, what do you do?
don't give OCs! and if needed, surgical exploration in the 2nd trimester is better for the fetus
If the female is postmenopausal and you find a small (3-5cm) mass, she is asymptomatic, with a normal CA-125, what do you do?
ultrasound q 3months then every 6month- in postmenopausal women, we are more aggressive since this is the age group more ovarian CA
You palpate a 7cm mass in a postmenopausal female. She has symptoms, a CA-125 of >35U/mL, ascites, and her mother had breast cancer what do you do?
Exploratory surgery by gyn/onc
When and how do follicular cysts arise?
in the normal process of ovulation, the follicle matures and ruptures to release the ovum - follicular cysts arise when rupture doesn't occur and the follicle continues to grow
When and how do corpus lutuem cyst arise?
in the normal process of ovulation, the ovum is release and the left over corpus lutuem involutes - corpus lutuem cysts arise when the corpus luteum fails to involute - can become hemorrhagic; these are BOTH physiologic or functional
compare the appearance of follicular vs. corpus luteum cysts.
Follicular= smooth, thin-walled and unilocular on US; Corpus luteum = complex and grossly yellow
A pregnant patient comes in for a visit and is growing newly apparent facial hair, what do you suspect?
Luteoma of pregnancy. Its a non-neoplastic ovarian mass that if appears, only occurs during pregnancy. should involute after delivery
Name the following mass. Non-malignant/benign epithelial ovarian tumor that is usually unilateral, unilocular, conatins clear yellow fluid and should be removed via laparoscopy or laparotomy.
Serous Cystadenoma
Name the following mass. This surface epithelial-stromal tumor is almost always benign, 90% unilateral, yellowish-brown in color, affects women in their 40-50s, and treatment is a TAHBSO.
Brenner Tumor- associated with Meig's Syndrome (pleural effusion and ascites - "I thought this was only in sex-cord tumors..."?-kiley)
Name the following mass. Arises from endometrial tissue and forms a "chocolate cyst"; often adherent to surrounding structures(bowel, etc); Ca-125 may be elevated; difficult to differentiate from benign hemorrhagic cyst and easy to see on ultrasound.
How do you diagnose endometriomas?
histopathology needed, clinical diagnosis made in women with endometriosis and adnexal mass; 50% of women with endometriosis get these; often bilateral; Use Ultrasound
How do endometriomas appear on US?
homogeneous low to medium level echoes in a thick-walled cystic mass (unilocular or multilocular); may be confused with hemorrhagic cyst
What are the indications for removal of endometriomas?
Indications: Relief of Pain, Exclusion of Malignancy, Infertility (may diminsh ovarian fxn)
How do you treat endometriomas?
removal (esp. if symptomatic); try and preserve the ovary (ovarian cystectomy) or oophorectomy (if done with bearing children and close to menopause anyway)
Is removal difficult and why?
difficult to excise a pseudocyst and if you spill the contents you may get scarring/adhesions
Name this mass. Appears in the first two decades of life, usually unilateral, almost always benign, most common germ cell tumor, consists of all 3 germ layers.
teratoma - (vs. in males, almost always malignant)
How should you treat a dermoid cyst (aka mature teratoma)?
Removal (always try to save the ovary since these are usually young women)
Name the teratoma that contains thyroid tissue.
Struma ovarii
This is a complication seen with PID. It makes a hydrosalpinx/pyosalpinx in the tube and/or ovary.
tubo-ovarian abscess - symptoms are consistent with PID (abdominal pelvic pain, fever, purulent vaginal discharge)
what is a hydrosalpinx and why does it cause problems?
its a fallopian tube filled with fluid (water, blood, pus); blocks the tubes and may cause the fimbria to close leading to infertility - usually a complication of PID
How does one diagnose a hydrosalpinx?
hysterosalpingogram (no spill); US (see sausage shaped fluid collection); Laparoscopy (direct visuallization)
If a woman had bilateral hydrosalpinx, how could she get pregnant?
bypass the fallopian tubes and do invitro fertilization (IVF) - directly take eggs out of the ovary, fertilize with sperm in the lab and transfer into the uterus.
name the technique that involves surgically opening up the fallopian tubes and what are the disadvantages?
neosalpingostomy; disadv: high recurrence rate and takes 6-12 months to heal prior to attempting pregnancy
What is the ultimate treatment of a hydrosalpinx?
What is the other name for the very common, usually multiple benign fibroids that vary in size and location of the uterus.
leiomyoma - mostly affect women in their 30-40s
Name the locations of the fibroids.
submucosal, intramural, and subserosal
List the signs and symptoms of a female with fibroids.
enlarging uterus and abdomen, pain/pressure in the abdomen/back; abnormal bleeding, urinary/bowel issues (BUT MOST OFTEN = 75% NO SYMPTOMS!!)
What is the connection between estrogen and fibroids?
estrogen causes fibroids to grow; this is the reason you won't see them causing problems in prepubescent and postmenopause
How do you diagnose fibroids?
history, PE, US (with doppler) and MRI
name the treatments for problem causing fibroids.
Meds (OCP, NSAIDS, Lurpon/Danazol); UAE (uterine artery embolization)- cut off supply; surgical removal; D&C; Hysteroscopic resection; abdominal myomectomy; Laparoscopic myomectomy (preserves fertility); hysterectomy