Malignancies of the Reproductive Tract Quiz

See Ovarian Cancer. Option E is correct. The ovaries drain primarily to the para-aortic lymph nodes, the chain of nodes lying alongside the abdominal aorta. This is not what the ovaries' pelvic position might suggest, and it is a classic exam trap. The reason is embryology, the way the organ developed before birth. The gonads develop high up on the back wall of the abdomen (within the mesonephric ridge) and then descend into the pelvis. They keep their original blood supply, with the ovarian arteries arising directly from the abdominal aorta, and their lymphatic vessels follow the ovarian vessels upwards to the para-aortic nodes. This is why staging of ovarian cancer requires assessment of lymph nodes beyond the pelvis. Some pelvic drainage also exists, but the para-aortic chain is the primary one. Memory aid: the ovaries start high on the back wall and bring their drainage with them.

• Primary drainage: the para-aortic lymph nodes beside the abdominal aorta.
• Reason: the ovaries develop high on the back wall and keep their blood supply from the aorta.
• Clinical point: staging of ovarian cancer needs assessment of nodes beyond the pelvis.