Ovary Basics for the Physician Assistant Exam

The two big medical conditions that can affect the ovaries are ovarian cysts and ovarian cancer. These will be covered on the Physician Assistant Exam. Ovarian cysts can cause abdominal and pelvic discomfort in women, and ovarian cancer is a cause of increased morbidity and mortality in older women. You don’t want to miss these conditions.

Ovarian cysts and PCOS

Ovarian cysts can be painless and asymptomatic. On the other hand, they can cause abdominal pain and bloating. Most of the time, the ovarian cyst goes away spontaneously without any surgical intervention. A simple ovarian cyst, if it’s painful, can usually be treated with oral contraceptives. Larger cysts, on the order of 10 cm, may need surgical removal.

One major cause of cysts on the ovaries is polycystic ovarian syndrome (PCOS), also called Stein-Leventhal syndrome. PCOS is a disorder of anovulation, and you usually see it in women in their late 20s and early 30s. This condition is characterized by amenorrhea, hypertension, impaired fasting glucose (or full-blown diabetes mellitus), obesity, and hyperlipidemia.

Often, the components of metabolic syndrome are present. Hirsutism and other features that may resemble Cushing’s syndrome, including the presence of abdominal striae, can also be present. A pelvic ultrasound can confirm the presence of ovarian cysts.

The treatment of PCOS includes weight loss. The diabetes medication metformin (Glucophage) may help with weight loss by decreasing insulin resistance and help alleviate some of the PCOS symptoms. You can also use hormonal therapy.

Ovarian cancer

Ovarian cancer is a leading cause of morbidity and mortality in older women. Risk factors for ovarian cancer include being of an older age (you usually see this cancer in postmenopausal women), using tobacco, being obese, being nulliparous, and undergoing hormonal therapy.

Note two other risk factors for ovarian cancer: If someone has a BRCA genetic mutation, she has an increased risk not only for breast cancer but also for ovarian cancer. Another risk factor for ovarian cancer is tamoxifen, which is used to treat estrogen- and progesterone-receptor positive breast cancer.

Signs and symptoms of ovarian cancer can include abdominal and pelvic pain and/or abdominal distention. Until proven otherwise, the presence of abdominal ascites in an older woman in the absence of liver disease/cirrhosis is ovarian cancer. Unfortunately, ovarian cancer is often silent until it’s well advanced.

Most of the time, you initially see the ovarian cancer on a pelvic ultrasound. Other radiologic studies, including a CT scan of the abdomen and pelvis, are used to stage the cancer after diagnosis. Laparoscopic surgery is often needed to confirm the diagnosis and obtain a tissue biopsy. At the time of diagnosis, there is often evidence of metastatic spread.

The treatment is often multifactorial and can include surgery (debulking surgery to remove as much tumor as possible) in combination with chemotherapy and radiation. The chemotherapy can be administered intravenously or intra-peritoneally.

The tumor marker CA-125 (MUC16) is used as a surveillance marker to detect reoccurrence of ovarian cancer. It’s not used to diagnose ovarian cancer.

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