Ovarian Tumors

Types of ovarian tumors

Borderline tumors (low malignant potential) sit between benign and malignant. They tend to occur in younger women, grow slowly and have an excellent outlook after surgery.

Tumors vs functional cysts

Most ovarian swellings in women of reproductive age are functional ovarian cysts, part of the normal ovulation cycle. They usually disappear within 1 to 3 cycles. Tumors are true new growths that do not resolve on their own. Endometriomas, cysts caused by endometriosis, are another common type.

Symptoms

Many ovarian tumors cause no symptoms and are found on an ultrasound done for another reason. When symptoms occur:

• pelvic or lower abdominal pain, aching or pressure
• bloating or a swollen abdomen
• feeling full quickly, loss of appetite
• needing to urinate often or urgently
• changes in bowel habit
• pain during sex
• irregular or abnormal vaginal bleeding

Hormone-producing tumors can cause early puberty in girls, irregular or postmenopausal bleeding (estrogen), or excess hair growth, acne and voice deepening (androgens).

Complications

• ovarian torsion: a tumor makes the ovary twist on its blood supply, causing sudden severe pain. It needs emergency surgery to save the ovary
• rupture or bleeding
• ascites (fluid in the abdomen), more typical of cancer

Risk factors for malignant ovarian tumors

• age, especially after menopause
• inherited mutations: BRCA1 and BRCA2, Lynch syndrome
• family history of ovarian, breast or colorectal cancer
• endometriosis (linked to clear cell and endometrioid types)
• never having been pregnant, and early periods or late menopause
• hormone therapy after menopause (small increase)

Protective factors include past pregnancies, breastfeeding, long-term use of combined birth control pills, and tubal ligation or removal of the fallopian tubes.

Diagnosis

• pelvic examination
• transvaginal ultrasound: the main test. Size, solid parts, internal walls, blood flow and fluid help classify risk using systems such as O-RADS or IOTA rules
• CA-125 blood test: often raised in epithelial ovarian cancer, especially after menopause. It can also be raised by endometriosis, fibroids, pregnancy and pelvic infection, so it is interpreted with care in younger women
• other markers in younger women with solid masses: AFP, hCG, LDH, inhibin
• MRI for uncertain masses
• CT scan if cancer is suspected, to look for spread
• referral to a gynecologic oncologist for masses with a high risk of cancer, which improves outcomes

Definitive diagnosis requires surgery and pathology.

Treatment

Monitoring

Simple-appearing cysts and many small benign-looking masses can be watched with repeat ultrasound, especially in premenopausal women.

Surgery

Surgery is recommended for masses that are suspicious, growing, large (often over about 10 cm), symptomatic, or at risk of torsion. Options:

• cystectomy: removing only the tumor while preserving the ovary, common for dermoids and benign tumors in younger women
• oophorectomy: removing the ovary, sometimes with the fallopian tube
• staging surgery for suspected cancer, performed by a gynecologic oncologist, which may include removing the uterus, both ovaries, lymph nodes and the omentum

Many benign tumors can be removed laparoscopically (keyhole surgery).

Ovarian cancer treatment

Surgery and chemotherapy are the mainstays, with PARP inhibitors and other targeted therapies for some women, particularly with BRCA mutations. See ovarian cancer.

Outlook

Benign ovarian tumors are cured by surgical removal. Borderline tumors have an excellent outlook. Ovarian cancer outcomes depend strongly on the stage at diagnosis; early-stage disease has much higher survival, which is why persistent symptoms deserve prompt evaluation.

Frequently asked questions

Are most ovarian tumors cancerous?

No. Most ovarian tumors are benign, especially in women before menopause. The risk of cancer rises with age, solid features on ultrasound, raised CA-125 after menopause, and inherited risk factors such as BRCA mutations.

What are the symptoms of an ovarian tumor?

Many cause no symptoms. When present, symptoms include pelvic pain or pressure, bloating, feeling full quickly, frequent urination and a swollen belly. Sudden severe pain may mean the ovary has twisted.

What is the difference between an ovarian cyst and an ovarian tumor?

Most ovarian cysts are functional, fluid-filled sacs from the normal menstrual cycle that disappear on their own. Ovarian tumors are new growths that persist, may be solid or cystic, and can be benign, borderline or malignant.

How are ovarian tumors treated?

Low-risk masses may be monitored with ultrasound. Suspicious, large or symptomatic tumors are removed surgically, often preserving the ovary when the tumor is benign. Cancer is treated with surgery and chemotherapy by a gynecologic oncologist.