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					Ovarian Tumours



     Max Brinsmead PhD FRANZCOG
                    October 2008
        Ovarian tumours present as:



Pain
Mass
An incidental finding

But the most important thing to determine is whether:
It is functional or neoplastic?
Benign or malignant?
After the identification of a pelvic adnexal mass
evaluation is usually by ultrasound but think…



 Is there a short history of symptoms?
 Is this a woman of reproductive age?
 Cycling spontaneously?
 Or using progestin-only contraception?
 A past history of “cysts”
 Pregnant?
 Had IVF?
   Pathology of Functional Ovarian Tumours:




A 2 cm “cyst” occurs every month = mature follicle

Haemorrhage from or into a corpus luteum is common

Failed follicular rupture can also result in a cyst

Endometrioma = ovarian endometriosis
Ultrasound features of a Functional Ovarian Tumour




   Thin walled
   Usually no solid components
   Usually no septa or thin walled septa
   Usually <6 cm size
   Usually avascular to colour Doppler
   Change rapidly
   And disappear within 6-8w
       • (A role for COC during this period)
Clinical Features of a Neoplastic Ovarian Tumour:

  Older women
  Larger tumours
  Solid/Cystic or multiple septate
  Bilateral
  Fixed, tender or craggy to palpation
  Ascites present
  Vascular to colour Doppler
  Persist or enlarge (4m re evaluation for
  postmenopausal women)
  Associated with positive tumour markers – CA125,
  CA19.9, CEA (AFP, HCG)
Differential diagnosis for an Ovarian Tumour:


Full bladder
Pregnancy
Loaded caecum or sigmoid colon
Hydrosalpinx
Mesenteric cyst
Fiboid (subserosal)
Pelvic kidney etc
Paraovarian cyst
        Pathology of Ovarian Neoplasms


    Teratoma
                – Benign cystic = Dermoid (the most common neoplasm of young women
                  – 15% bilateral)
                – Malignant variations can occur
    Epithelial
                – Cystadenoma (serous and mucinous)
                – Cystadenocarcinoma Serous
                –                      Mucinous
                –                      Endometroid
                –                      Clear cell adenoCa
    Functional
                – E2 producing (granulosa cell benign or malignant)
                – Androgen producing (Androblastoma)
    Secondary Cancers (Stomach, Bowel, Breast etc)
NB Ovarian cancer is a peritoneal disease
       Staging of Ovarian Cancer:


Stage 1A - Confined to one ovary
       1B - Ascites or +ve peritoneal cytology
Stage 2A - Involves uterus or tubes
      2B - Involves other pelvic viscera
Stage 3A - Confined to pelvis
     3B - to lymph nodes or upper abdominal implants >2cm
Stage 4 - Distant metastases
    Treatment of Ovarian Cancer:


Debulking surgery = TAH + BSO+Omentectomy
Chemotherapy
Radiotherapy
Special cases
   • Children
   • Young woman – no children
   • Advanced disease
       Prognosis for ovarian cancer:


Overall 30 – 35% but this is because it presents
late

With modern gynaecological oncology
(debaulking + aggressive combination
chemotherapy) it should be >50%
                 Preventing ovarian cancer:



   Screening                - Vaginal exams
                            - Ultrasound
                            - CA125
Have been disappointing – too many false positives


   Prophylactic Oophorectomy
                  - at hysterectomy (40%)
                  - for genetically predisposed
                            (BRAC carriers)

				
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