Ovarian Tumors

Ovarian Tumors

1. Introduction

a. Malignant ovarian tumors are the leading cause of death from reproductive tract cancer.

b. Majority of ovarian tumors are benign.

c. General lifetime risk is 1.6% and 5% with a first degree family relative.

d. Lifetime risk with BRCA1 gene is 45% and with BRCA2 gene is 25%.

2. Clinical Findings

a. Symptoms and Signs

i. Most patients are asymptomatic.

ii. Mild nonspecific gastrointestinal symptoms or pelvic pressure

iii. Pelvic exam can detect early disease.

iv. Advanced disease can present with bloating, abdominal pain, ascites, and palpable abdominal mass.

b. Lab Findings

i. CA 125 level greater than 35 units can indicate malignancy.

ii. CA 125 elevated in 80% of epithelial ovarian cancer and only 50% in early disease.

c. Imaging Studies

i. Transvaginal Ultrasound for screening

ii. Ultrasound helps differentiate from benign and malignant neoplasm.

3. Differential Diagnosis for an Ovarian Mass

a. Functional

b. Benign Neoplastic

i. Premenopausal woman, asymptomatic, mobile, unilateral, simple cystic mass less than 7.5 cm

c. Potentially Malignant

d. Predictive factors include age, size of the mass, ultrasound configuration, CA 125 levels, symptoms, and symmetry

4. Treatment

a. Malignant neoplasm – surgical staging, abdominal hysterectomy, bilateral salpingo-oophorectomy

i. Advanced disease

1. removal of all visible tumor

2. post-operative chemotherapy

a. cisplatin or carboplatin with paclitaxel

b. Benign neoplasms – tumor removal or unilateral oophorectomy

5. Prognosis (5 yr survival)

a. Distant metastases – 17%

b. Local spread – 36%

c. Early disease – 89%

Source:

1. Tierney, Jr, Lawrence M., Stephen J. McPhee, and Maxine A. Papadakis. Current Medical Diagnosis & Treatment 2005. 44th ed. New York: McGraw Hill, 2005: 719-722.