Mgr university bsc nursing adult health previous question paper with answers
Malignant ovarian cysts
1. BY
AHMED MOHAMED DIAA ABDELKALK 6105
AHMED MOHAMED ABDELAZIZ ELSHRIF 6106
AHMED MOHAMED ABDALLAH TAHA 6107
AHMED MOHAMED ORIF MOHAMED 6108
AHMED MOHAMED FOA’AD SALEM 6109
Malignant ovarian cysts
2. Ovarian cysts
Overview :
Ovarian cysts are fluid-filled pockets called sacs that
can form in the ovaries. They are very common and
can affect women of any age, although they are more
frequent in women of childbearing age because they
are linked to ovulation.
Often a cyst develops and disappears without the
woman even knowing that she had one. Cysts in pre-
menopausal women can produce symptoms similar
to those for ovarian cancer but are not known to
increase the risk of ovarian cancer
3. Ovarian cysts, also known as ovarian masses, are
frequently found incidentally in asymptomatic
women.
Ovarian cysts can be physiologic (having to do with
ovulation) or neoplastic and can be benign,
borderline (low malignant potential), or
malignant.
Ovarian cysts are sometimes found in the course of
evaluating women for pelvic pain though the cysts
may or may not be the cause of the pain.
Definition
4. Pathophysiology
Physiologic/Functional Cysts
During normal ovulation, a follicle matures and then
ruptures, releasing an oocyte. After ovulation, the
corpus luteum forms and subsequently involutes.
When the follicle fails to rupture and continues to
grow, a follicular cyst occurs. When the corpus
luteum fails to involute and continues to grow, a
corpus luteum cyst occurs. Both types of cysts are
considered physiologic or functional and neither
have any malignant potential.
5. Neoplastic ovarian cysts
A tumour (also known as a neoplasm) is any abnormal
mass of tissue (collection of cells).
Like a cyst, a tumour can form in any part of the body.
A tumour can be benign (non-cancerous),
malignant (cancerous) or borderline (between
malignant and benign).
6. Symptoms
Most women with benign or malignant ovarian cysts
are asymptomatic and the cysts are found
incidentally.
General : cachexia ,metastasis
Abdominal : pelvic or lower-abdominal pressure or
pain most common , distention or bloating, and
difficulty eating or early satiety have also been
reported
Local : pain , haemorrage ,annovulation
7.
8. Signs
General : Cachexia, fever, LL edema, Wirchow LN
enlargement , may associate with hormonal effect
Abdominal : pelviabdominal mass , Acitis ,
umbilical nodules (sister marry josef )
Local : menestrual irregularity , painful intercourse
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12. Spread of Malignant ovarian cyst
Direct early to uterus ,tube , other ovary , peritoneum
Lymphatic pelvic ----Para aortic ----Virchow
Blood late liver , lung ,bone , brain
13. Stages of ovarian cancer FIGO 1986
Ovarian -1- A) one ovary B) two ovaries
Pelvic - 2 - A) tubes + - uterus
B) other pelvic organ
C) pelvic spread
Abdomen -3- A) microscopic metastasies , no LN
B) implants less than 2cm , no LN
C) implants more than 2cm or LN
Distant -4- Includes liver parynchema or present in
pural fluid
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17. Diagnosis
The diagnosis of an ovarian cyst is most often made based on
imaging rather than by physical examination, laboratory
testing, or diagnostic procedures.
Ultrasound
Ultrasonography is considered the gold standard for the
assessment of ovarian cysts. Transvaginal sonography is
preferred, as the probe proximity to the ovary can result in
superior images. If transvaginal sonography is not
available or not tolerated by the patient, transabdominal
sonography through a full bladder or transperineal
sonography in virginal or atrophic women can still provide
helpful, albeit limited, information.
18.
19. Ovarian malignancy features solid areas that are not hyperechoic (especially if blood flow to
them); thick septations ( >2 - 3 mm wide, especially if blood flow within them); excrescences
on inner/outer aspect of a cystic area; ascites; other pelvic/omental masses.
20. Characteristics of Simple and Malignant Cysts
Malignant cystSimple cyst
Non-hyperechoic solid areas (especially
if blood flow)
Round or oval
Solids ,Other pelvic/omental massesNo solid component
Irregular wallSmooth, thin walls
Excrescences on inner/outer aspect of
cystic area
No internal flow
Thick septations ( >2 - 3 mm wide,
especially if blood)
No septation
AscitesPosterior acoustic enhancement
21. "Simple Rules" Differentiating Benign and Malignant
Cysts
Malignant (M) featuresBenign (B) features
M1 irregular solid tumorB1 unilocular cyst
M2 ascitesaB2 solid components present, but <7
mm
M3 at least 4 papillary structuresB3 acoustic shadows
M4 irregular multilocular-solid tumor,
largest diameter ≥100 mmb
B4 smooth multilocular tumor, largest
diameter <100 mm
M5 very strong flow; color score 4B5 no blood flow; color score 1
22. Complications
Ovarian torsion: all ovarian cysts have the potential to twist
on their axes or "torse," occluding vascular supply. Larger cysts
(over 6 cm) are more likely to torse. Ovarian torsion is a surgical
emergency as the ovary must be promptly untwisted to restore
perfusion and preserve ovarian tissue. Ultrasound with Doppler
can identify lack of blood flow to the ovary.
Cyst rupture: all cyst types can potentially rupture, spilling
fluid into the pelvis, which is often painful. If the contents are
from a dermoid or abscess, surgical lavage may be indicated.
Hemorrhage: In the case of hemorrhagic cysts, the
management of hemorrhage depends on the hemodynamic
stability of the patient, but is most often expectantly managed
