Ovarian Tumor

Ovarian tumor = tumor arising on the ovary. It is one of the common tumors of the female genital tract. Ovarian malignancy also has the highest mortality among gynecologic malignancies. Despite great advances in basic research and clinical diagnosis/treatment of ovarian malignancy in recent years, the 5-year survival rate has not improved markedly.

Common Symptoms

Abdominal mass; ovarian amenorrhea; ovarian enlargement; ascites; ovarian hirsutism; follicle-stimulating hormone (FSH); abdominal-muscle rigidity; abdominal pain; nausea; pelvic meningocele

Causes and Pathogenesis

Ovarian tumors have higher incidence in women with early menarche, late menopause and nulliparity; risk is reduced by multiparity, breastfeeding and oral contraceptives. The 'incessant ovulation' theory holds that ovulation damages ovarian epithelial cells, and repeated injury-repair cycles promote canceration. Heredity: one of the most studied etiologies; most cases are autosomal-dominant. If mother or sister has one or two types of cancer, the patient's risk of ovarian malignancy is 50%. Pathogenesis: 1. Mechanisms: 'Incessant ovulation' theory: high incidence in early-menarche/late-menopause/nulliparous women, reduced risk in multiparous/lactating/OCP users; ovulation damages ovarian epithelium and repeated injury-repair promotes canceration. Genetic factors: most cases autosomal-dominant; in the last decade molecular genetics advanced greatly. Narod et al. found a specific gene predisposing to hereditary breast-ovarian cancer (HBOC) syndrome on chromosome 17, now called BRCA1; recently another susceptibility gene BRCA2 was identified on chromosome 13; mutations in these two genes make most epithelial ovarian malignancies heritable. Hereditary ovarian malignancies are mainly of three types: (1) High-risk: familial ovarian malignancy syndrome — if mother/sister has ovarian malignancy, the patient is high risk. (2) 50% risk: breast-ovarian malignancy syndrome — if mother/sister has one or two types of cancer, the patient has 50% risk of ovarian malignancy. (3) Cancer-family history: risk of ovarian malignancy, endometrial cancer, breast cancer and colorectal cancer may all be increased. 2. Pathology: (1) Histologic classification (Table 1); (2) Histologic grade per Broder: undifferentiated cells 0%-25% = G1; 25%-50% = G2; >50% = G3.

Treatment

Drug therapy, supportive therapy, surgery

Preventive Measures

(1) Promote a high-protein, high-vitamin A/C/E diet; avoid high-cholesterol diet. High-risk women should use oral contraceptives. (2) Women over 30 have an annual gynecologic exam; high-risk groups should start screening from childhood; B-ultrasound and routine alpha-fetoprotein testing. (3) Early detection and early management. Ovarian cystic masses >6 cm should be surgically excised and sent routinely for pathology, because benign masses may still malignant-transform with continued growth. Solid ovarian masses should be operated as soon as possible regardless of size; frozen section intraoperatively determines surgical extent. Pelvic masses with unclear diagnosis or failure of conservative treatment should undergo early laparoscopy or exploratory laparotomy. Breast and GI cancer patients should have routine postoperative gynecologic exams and regular follow-up for early detection of metastatic cancer.

Department to Visit

It is recommended to visit the Surgical Oncology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.