Ovarian tumors can be benign, that is noncancerous, or malignant, that is cancerous. The most common symptoms are abdominal swelling and pain. The treatment is mainly surgical in both benign and malignant ovarian tumors.
Types of Ovarian Tumors
Ovarian tumors are classified into 5 main types: epithelial tumors, stromal tumors, germ cell tumors, metastatic tumors and others. Epithelial tumors are the most common (75% of all ovarian tumors and 90-95% of all malignant or cancerous ovarian tumors). They arise from the cells found on the surface layer of ovaries.
Stromal tumors (5-10% of all ovarian tumors) arise from cells responsible for producing female hormones. Germ cell tumors (15-20% of all ovarian tumors), which are mostly benign, arise from cells that are responsible for producing eggs. Metastatic tumors (5% of malignant ovarian tumors) are cancerous ovarian tumors whose primary is elsewhere, such as breast, stomach, colon, endometrium of uterus and cervix. Other tumors can arise from the soft tissue of ovaries.
Benign Ovarian Tumors
The vast majority (90%) of ovarian tumors are benign. The most common are cystic teratomas (also known as dermoid cysts), which contain a variety of tissues like hair, teeth and bone.
Benign ovarian tumors often do not cause any symptoms and are sometimes discovered incidentally, for example when X-ray of abdomen is taken. The symptoms they can cause are abdominal pain, abdominal swelling and pressure effects on bladder and bowel.
The pain is usually due to torsion of the cyst or bleeding inside the cyst. There can be lower back pain, painful menstruation, difficulty in urination, increased frequency of urination, difficult or painful bowel movements, constipation and pain when having sex.
Bimanual examination can distinguish between fibroid uterus and ovarian cyst, but it needs to be confirmed by ultrasound scan. Ultrasound can show cystic fluid and other features which can distinguish it from cancerous conditions. Hormone assays like checking of estrogen and androgen levels are indicated to rule out hormone-producing cysts. Diagnostic laparoscopy may sometimes be necessary, at which time laparoscopic removal can also be undertaken if appropriate.
Cysts less than 5 cm in diameter and which are causing no symptoms do not require any treatment because they usually undergo spontaneous resolution. Asymptomatic cysts greater than 5 cm in diameter need to be followed up – if they enlarge, they need to be removed.
Cysts that are symptomatic or rapidly enlarging need to be removed. If the ovarian cyst undergoes torsion, as indicated by acute pain, it is an emergency and the cyst needs to be removed to prevent the ovarian tissue from dying due to lack of blood supply.
Malignant Ovarian Tumors (Ovarian Cancer)
They usually occur in women between the ages of 50 and 70 years. They are more common in those who have not borne any children and those with a family history. Use of combined oral contraceptives is protective against the development of ovarian cancer.
The presentation is usually with abdominal pain and swelling. There can be increased frequency of urination, difficulty in urination, weight loss, dyspeptic symptoms and abnormal monthly periods.
There can also be loss of appetite, nausea and vomiting, and constipation. Sometimes the symptoms can be vague due to metastasis (spread of ovarian cancer to other sites of the body), for example shortness of breath, gastrointestinal upset or altered bowel habits.
Ultrasound is the first-line investigation. Elevated levels of cancer antigen 125 (CA-125) are usually found in 80% of cases. CT and MRI can help in assessing the extent of the cancer prior to surgery.
Surgery is the mainstay of treatment for ovarian cancer. Surgery is usually followed by combination chemotherapy, particularly in advanced stages of the disease. Radiotherapy is used less frequently.
Photo Credit: http://uvahealth.com/services/cancer-center/conditions-treatments/11638