Ovarian Tumours - PowerPoint by liuqingzhan


									Ovarian Tumours

     Max Brinsmead PhD FRANZCOG
                    October 2008
        Ovarian tumours present as:

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”
 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
  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
Loaded caecum or sigmoid colon
Mesenteric cyst
Fiboid (subserosal)
Pelvic kidney etc
Paraovarian cyst
        Pathology of Ovarian Neoplasms

                – Benign cystic = Dermoid (the most common neoplasm of young women
                  – 15% bilateral)
                – Malignant variations can occur
                – Cystadenoma (serous and mucinous)
                – Cystadenocarcinoma Serous
                –                      Mucinous
                –                      Endometroid
                –                      Clear cell adenoCa
                – 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
Special cases
   • Children
   • Young woman – no children
   • Advanced disease
       Prognosis for ovarian cancer:

Overall 30 – 35% but this is because it presents

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)

To top