Ovarian Tumours

Overview – Ovarian Tumours

Ovarian tumours include a spectrum from benign cystadenomas to malignant ovarian carcinomas (cystadenocarcinomas) and germ cell-derived teratomas (dermoid cysts). These lesions present diagnostic and therapeutic challenges due to their often asymptomatic nature and high malignancy rates at late stages.

1. Ovarian Cystadenoma (Benign)

Aetiology

  • Unknown

Pathogenesis

  • Tumour of ovarian surface epithelium

Morphology

  • Macro:
    • Often large (>20 cm), uni/multiloculated
    • Cystic, filled with clear fluid or mucin
    • Minimal solid tissue
  • Micro:
    • Cyst wall lined by cuboidal/columnar epithelium
    • May be flat or have small papillary projections
    • ± Psammoma bodies (calcifications)

Clinical Features

  • Demographics: Common in women aged 20–45
  • Symptoms:
    • Gradual: abdominal fullness, heaviness
    • If ruptured: sudden sharp adnexal pain → radiates to pelvis/back/thighs
  • Diagnosis:
    • Ultrasound
    • CT scan
    • Biopsy (definitive)
  • Complications:

Treatment

  • Analgesia (paracetamol/NSAIDs)
  • COCP to prevent further follicle stimulation
  • Non-medical: warm baths, heat packs
  • Surgery if large, persistent, or life-threatening

Prognosis

  • Benign (~85%)
  • Excellent prognosis
OVARIAN CYSTADENOMA
Euthman, Public domain, via Wikimedia Commons

2. Ovarian Cancer (Cystadenocarcinoma)

Aetiology

  • Unknown
  • Risk factors:
    • Age >40
    • BRCA1/2, HNPCC
    • Unopposed estrogen (early menarche, late menopause, nulliparity)
    • Smoking, family history
    • OCP & multiparity are protective

Pathogenesis

  • Carcinogenesis of ovarian serous epithelium

Morphology

  • Solid tumour (often with mixed solid-cystic features)

Clinical Features

  • Early stages (I–II): usually asymptomatic
  • Later stages:
    • Pelvic/abdominal pain, bloating, GI/urinary symptoms
    • Irregular periods
    • Ascites, weight loss, anorexia
    • Fixed, solid abdominal/pelvic mass

Diagnosis

  • Pelvic exam + transvaginal USS
  • CT abdomen/pelvis
  • Histology confirms diagnosis
  • CA-125 is not for diagnosis – used for monitoring

Treatment

  • Surgical debulking
  • Intensive chemotherapy
  • +/- radiotherapy

Prevention

  • Routine screening NOT recommended (due to low sensitivity/specificity of CA-125 and USS)
  • High-risk women (e.g. BRCA+, family history):
    • Annual screening from age 35 with:
      • Pelvic exam
      • Transvaginal USS
      • CA-125
    • Consider prophylactic bilateral salpingo-oophorectomy (BSO)
    • +/- mastectomy if BRCA+ due to high breast cancer risk

Prognosis

  • Malignant (~15%)
  • Often diagnosed late → Poor prognosis
    • Stage I (ovaries only): 88% 5YS
    • Stage II (uterus): 60%
    • Stage III (peritoneum): 27%
    • Stage IV (distant mets): <10%
OVARIAN CANCER
Rathore, Muhammad Usman et al. Journal of the College of Physicians and Surgeons–Pakistan : JCPSP 23 6 (2013)

3. Dermoid Cyst (Teratoma)

Aetiology

  • Often congenital – slow-growing
  • Derived from pluripotent germ cells

Morphology

  • Macro:
    • May contain hair, teeth, skin, brain, fat, etc.
  • Micro:
    • Mature tissues from multiple germ layers
    • Encapsulated

Clinical Features

  • Pelvic/abdominal pain
  • Detected via imaging
  • Histology confirms

Complications

Treatment

  • Surgical removal

Prognosis

  • Benign
  • Excellent prognosis
DERMOID CYSTS
DERMOID CYSTS
1. Photograph by Ed Uthman, MD., Public domain, via Wikimedia Commons
2. Unattributable

Summary – Ovarian Tumours

Ovarian tumours can be benign (e.g. cystadenomas, dermoid cysts) or malignant (e.g. cystadenocarcinomas). Symptoms are often vague and diagnosis delayed. Ovarian cancer has poor prognosis due to late detection, but benign tumours typically have excellent outcomes with surgical management. For more resources, visit our Reproductive Health Overview page.

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