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APGO educational topic number 55
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ovarian neoplasms ovarian cancer is the
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fifth most common cause of cancer death
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in women in the United States ovarian
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cancer has the highest mortality rate
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among gynecologic malignancies
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approximately 55% of patients will die
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within five years of diagnosis the
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objectives of this video are to describe
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the initial management of a patient
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within an X amass compare the
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characteristics of functional cysts
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benign ovarian neoplasms and ovarian
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cancers list the risk factors and
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protective factors for ovarian cancer
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describe the symptoms and physical
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findings associated with ovarian cancer
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and lastly describe the three
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histological categories of a very
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neoplasm what is an in Exel mass and
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gynecology it refers to anything next to
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the uterus usually involving the
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fallopian tube or ovary the term adnexal
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mass is often used interchangeably with
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the term mass when a patient presents
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with an x amass it is important to
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perform a thorough pelvic examination
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for preman Arkell girls the ovary should
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not be palpable for reproductive age
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group women a normal ovary is palpable
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about half of the time and for
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postmenopausal women the ovaries are
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usually not palpable 25% of ovarian
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tumors in postmenopausal women are
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malignant whereas 10% of our variant
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tumors in reproductive age women are
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malignant pelvic ultrasound is the
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primary component of evaluation of an
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annexe amass the three main
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classifications of an exhalation Allah
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cysts number two benign ovarian
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neoplasms and number three malignant
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ovarian neoplasms functional cysts are
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physiologic and formed from normal
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ovulatory function they are composed of
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follicular cyst and corpus luteum cysts
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and they will spontaneously resolve
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functional cysts require surgical
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intervention only if they become
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symptomatic for instance if the size
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becomes large if there’s torsion or if
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there’s uncontrolled bleeding into the
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cysts which is known as a hemorrhagic
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cyst
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there are three histological cell types
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that give arised a benign and malignant
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ovarian neoplasms let’s spend a moment
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to discuss these three cell types here
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is the ovary and it is lined by
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epithelial cells shown here in blue here
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is a follicle and in the follicle there
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are granulosus
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and theca cells represented here in pink
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these cells are referred to as the
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stromal cells the third type of cell in
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the ovary are the germ cells that are
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the precursor cells to gametes
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represented here in purple so it is
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these three histological cell types
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epithelial stromal and germ cell that
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give a rise to benign and malignant
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ovarian neoplasms there are multiple
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specific benign and malignant tumors
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within each of these three cell types we
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will start with benign ovarian neoplasms
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about 25% of an exome asses in
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reproductive age women are benign
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neoplasms the epithelial are the largest
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class of ovarian neoplasms serous
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mucinous and endometrioid are the most
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common benign epithelial neoplasms the
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germ cell type are derived from the
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primary germ cell and thus may contain
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relatively differentiated structures
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such as hair and bone the mature cystic
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teratoma known as a dermoid is the most
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common tumor found in women of all ages
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it is often in premenopausal women and
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demonstrate tissues of all three
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embryologically cell types ectodermal
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mesodermal and endodermal lastly the
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stromal cell type benign ovarian
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neoplasm is derived from specialized sex
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cord stroma of the developing gonad two
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examples are fibromas or the– comas
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Manx syndrome is a benign ovarian
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fibroma plus society’s plus a right
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pleural effusion let’s now move to
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malignant ovarian neoplasms epithelial
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cell type consists of 90 percent of all
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ovarian malignancies serous endometrial
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mucinous and clear cell are all
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epithelial malignant ovarian neoplasms
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the germ cell type is the most common
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ovarian cancer in women less than 20
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years old
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these may be functional producing beta
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HCG or alpha-fetoprotein dis German
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Oma’s endodermal sinus tumors and
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immature teratomas are examples of germ
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cell malignant ovarian neoplasms and
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lastly sex chord stromal type produce
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hormones granulosa cells – MERS may
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secrete large amounts of estrogen and
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sertoli related tumors may secrete large
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amounts of androgen these sex chord
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stromal tumors are rare let’s move now
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to patient presentation from malignant
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ovarian neoplasms women most commonly
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present in their fifth decade of life
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and they may present with abdominal
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bloating
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distension abdominal or pelvic pain
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early satiety urinary urgency or
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decreased energy it is important to note
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that the most common symptoms are
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gastrointestinal and not gynecological
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symptoms approximately one out of 70
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women will develop ovarian cancer during
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her lifetime and risk factors include
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Nullah parity primary and fertility
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endometriosis and inherited mutations
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such as BRCA and hnpcc protective
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factors on the other hand include taking
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oral contraception for at least five
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years having a history of a tubal
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ligation or history of a hysterectomy
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moving now to evaluation it is very
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important for both the patient and her
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clinician to be aware of early warning
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signs of ovarian cancer for radiological
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imaging pelvic ultrasound is the best
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first line test and a ca-125 is most
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helpful in postmenopausal woman with a
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pelvic mass this is because there are
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many cases of elevated ca-125 in
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premenopausal women for reasons such as
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fibroids PID and endometriosis that make
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it less useful surgical exploration is a
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definitive next step in the evaluation
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when there is a high suspicion this
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concludes the aapko video on our variant
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neoplasms we’ve discussed the
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characteristics and management of
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functional sister line ovarian neoplasms
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and malignant ovarian neoplasms as well
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as discussing the risk factors and
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protective factors for ovarian cancers
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remember to always have a high clinical
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suspicion to rule out ovarian cancer
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you