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20-22: Ovarian Tumors & Ovarian Cancer

Jill Brown; Katerina Shvartsman

ESSENTIALS OF DIAGNOSIS

ESSENTIALS OF DIAGNOSIS

  • Symptoms include vague GI discomfort, pelvic pressure, or pain.

  • Many cases of early-stage cancer are asymptomatic.

  • Pelvic examination and ultrasound are mainstays of diagnosis.

GENERAL CONSIDERATIONS

Ovarian tumors are common. Most are benign, but malignant ovarian tumors are the leading cause of death from gynecologic cancer. The wide range of types and patterns of ovarian tumors is due to the complexity of ovarian embryology and differences in tissues of origin (eTable 20–3).

eTable 20–3.Ovarian functional and neoplastic tumors.
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eTable 20–3. Ovarian functional and neoplastic tumors.
Tumor Incidence Size Consistency Menstrual Irregularities Endocrine Effects Potential for Malignancy Special Remarks
Follicle cysts Rare in childhood; frequent in menstrual years; never in postmenopausal years. < 6 cm, often bilateral. Moderate Occasional Occasional anovulation with persistently proliferative endometrium None Usually disappear spontaneously within 2–3 months.
Corpus luteum cysts Occasional, in menstrual years. 4–6 cm, unilateral. Moderate Occasional delayed period Prolonged secretory phase None Functional cysts. Intraperitoneal bleeding occasionally.
Theca lutein cysts Occurs with hydatidiform mole, choriocarcinoma; also with gonadotropin or clomiphene therapy. To 4–5 cm, multiple, bilateral. (Ovaries may be ≥ 20 cm in diameter.) Tense Amenorrhea hCG elevated as a result of trophoblastic proliferation None Functional cysts. Hematoperitoneum or torsion of ovary may occur. Surgery is to be avoided.
Inflammatory (tubo-ovarian abscess) Concomitant with acute salpingitis. To 15–20 cm, often bilateral. Variable, painful Menometrorrhagia Anovulation usual None Unilateral removal indicated if possible.
Endometriotic cysts Never in preadolescent or postmenopausal years. Most common in women aged 20–40 years. To 10–12 cm, occasionally bilateral. Moderate to softened Rare None Very rare Associated pelvic endometriosis. Medical treatment or conservative surgery recommended.
Teratoid tumors:              
Benign teratomas (dermoid cysts) Childhood to postmenopause. < 15 cm; 15% are bilateral. Moderate to softened None None Rare Torsion can occur. Partial oophorectomy recommended.
Malignant teratomas < 1% of ovarian tumors. Usually in infants and young adults. > 20 cm, unilateral. Irregularly firm None Occasionally, hCG elevated All Surgery alone may be curative.
Cystadenoma, cystadenocarcinoma Common in reproductive years. Serous: < 25 cm, 33% bilateral; mucinous: up to 1 cm, 10% bilateral. Moderate to softened None None > 50% for serous, about 5% for mucinous Peritoneal implants often occur with serous, rarely with mucinous. If mucinous tumor is ruptured, pseudomyxoma peritonei may occur.
Endometrioid carcinoma 15% of ovarian carcinomas. Moderate, 13% bilateral. Firm None None All Adenocarcinoma of endometrium coexists in 15–30% of cases.
Fibroma < 5% of ovarian tumors. Usually < 15 cm. Very firm None None Rare Ascites in 20% (rarely, pleural fluid).
Arrhenoblastoma Rare. Average age 30 years or more. Often small (< 10 cm), unilateral. Firm to softened Amenorrhea Androgens —elevated < 20% Recurrences are moderately sensitive to irradiation.
Theca cell tumor (thecoma) Uncommon. < 10 cm, unilateral. Firm Occasional irregularity Estrogens or androgens elevated < ...

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