FOLLICULAR CYST

CORPUS LUTEAL CYST

NON-NEOPLASTIC
FUNCTIONAL CYST

GRANULOSA-THECA LUTEAL
POLYCYSTIC
ENDOMETRIOTIC
CYST

EPITHELIA
L
OVARIAN
NEOPLAS
M

PRIMARY

GERM
CELL
TUMORS

BENIGN
BORDERLIN
E
MALIGNANT

DERMOID CYST
MALIGNANT

MUCINOU
S
SEROUS
ENDOMETRIOI
CLEAR CELL
(MESONEPHROI
D)
BRENNET

SOLID
TERATOMA
NONGESTATIONAL
CHORIOCARCINO
YOLK SAC

DYSGERMINO
MA
FIBROMA (MEIGS
GERM CORD
(GONADAL STROMAL)
TUMORS
SECONDARY

ANDROGEN SECRETING TUMOR

GRANULOSA-THECA CELL
TUMORS

FOLLICULAR CYST
- Usually less than 5 cm
- Benign and asymptomatic
- Thin wall, contain clear fluid
- Rescan in 4 weeks
- If enlarge or symptomatic,
consider surgery

OVARIAN NEOPLASM
NON-NEOPLASTIC FUNCTIONAL CYST
CORPUS LUTEAL CYST
GRANULOSA-THECA LUTEIN
CYST
Excessive bleeding into corpus - in molar pregnancy or part
luteum
of hyperstimulation
Cyst filled with blood
syndrome
- Due to excessive
Delayed period + pain
gonadotrophin
Usually the following period is
heavy

POLYCYSTIC OVARY
ENDOMETRIOTIC
CYST

PRIMARY OVARIAN TUMORS

A] EPITHELIAL
- Benign
- Borderline:
Epithelial tumors with no invasion of basement membrane
15% of epithelial tumors, mostly serous and stage 1 (70-85%).
10 year survival is 95%. Late recurrence.
Extensive histological sectioning is essential to exclude invasion.
- Malignant
MUCINOUS
SEROUS
ENDOMETRIOD
- Large tumors.
- Most common
- Few cases arise in
Multilocular filled with
endometriosis
- Contain clear fluid
mucin
- 30% coexist with
- Often bilateral.
- If ruptured
primary endometrial
Around age of
pseudomyxoma
cancer
menopause
peritonei
- Malignant type is
the commonest
ovarian cancer

BRENNER
- Usually benign.occur
in reproductive life
- May be associated
with endometrial
hyperplasia
- May coexist with
mucinous
cystadenoma

CLEAR CELL
@MESONEPHROID
- Associated with
endometriosis in 25%
- Worst prognosis

OVARIAN NEOPLASM
PRIMARY OVARIAN TUMORS
B] GERM CELL TUMORS
BENIGN
DERMOID CYST @ BENIGN CYSTIC
TERATOMA
- 25% of all ovarian neoplasm
- Contain tissue derived from two or
more germ cell layers
- Unilocular cyst. May contain teeth,
bone , cartilage, nerves, hair, thyroid,..
Tissues
- Almost always benign. Malignant
changes may occur in any component
- Occur at any age. Peak is 20-30 years.
- Bilateral in 20%

MALIGNANT
Rare. 3% of ovarian cancers
SOLID
TERATOMA
Peak
incidence in
second
decade

NONGESTATIONAL
CHORIOCARCINO
MA
- Secrete HCG
- May be
component of
solid teratoma

YOLK SAC @
ENDODERMAL
SINUS
- Highly malignant.
Affect young age
- Partly solid.
Secrete alpha fetoprotein

DYSGERMINOMA

- Most common.
Highly malignant
- Usually spread by
lymphatics
- Very radiosensitive
- Occur in young
women. May arise in
gonadal dysgenesis

C] GERM CORD @ GONADAL STROMAL @ SEX CORD TUMORS

GRANULOSA THECA CELL TUMOR
ANDROGEN-SECRETING TUMORS
FIBROMA
- Moderate to large size
- Androblastoma
- Solid tumor
- Solid, as enlarge may have cystic
- Sertoli-leydig
- May be associated with meigs
spaces
- Gynandroblastoma
syndrome
- Yellow tinge on cut surface
Cause virilization
- Tend to have long pedicle
- Thecoma is benign, but granulosa is
malignant
- Occur at any age .50%
postmenopausal
- Secrete estrogen
- Usually stage 1. Late recurrence
SECONDARY @ METASTATIC OVARIAN TUMORS
Always bilateral. From mucin secreting tumors, stomach and colon (Krukenberg tumors)
May be secondary to breast

INTRODUCTION
- Wide variety of tumors
- 25% of female genital tract
tumors
- In U.K, the most common
pelvic cancer
- Worst prognosis of all
female genital tract cancers
- Life time risk is 1%
- Spread by local spread,
lymphatic and rarely by blood

MALIGNANT EPITHELIAL OVARIAN TUMORS

ETIOLOGY
PRESENTATION
PHYSICAL FINDINGS
Risk Factors:
Silent disease 75%
Benign:
Nulliparity, Family
- Usually mobile. unless large or
present at advanced
history, Fertility
complicated
stage
drugs
- Dermoid cyst anterior to bladder
Symptoms of
Protective Factors:
Malignant:
abdominal
Number of
- Bilateral
involvement
pregnancies, OCCP,
- Ascites
Symptoms of distant
Tubal ligation.
- Hard deposit in pelvis
metastases
- Leg edema
General malaise,
- Signs of bowel obstruction of ureteric
weight loss
obstr
Hormonal production

COMPLICATION
Torsion
- common with dermoid/fibroma
- Severe abdominal pain/vomitting
Rupture
Haemorrhage
Impaction
infection

OVARIAN TUMOR IN PREGNANCY

Found incidentally
Corpus luteal/dermoid
2% are malignant
If discover early and persist ,
surgery around 16 weeks
If complicated, operate immediately

FIGO STAGING
Stage
Growth limited to one or both ovaries
1
Stage
Growth limited to one or both ovaries with
2
pelvic extension
Stage
Tumor involving one/both ovaries with
3
peritoneal implants outside pelvis/positive
retroperitoneal or inguinal nodes.

INVESTIGATION
Uss /CT scan
Tumor markers( ca125,CEA,
HCG,alpha FP
Urea and electrolyte
LFT
Chest X ray
Ascitic tap
Calculate risk malignancy index.

RISK MALIGNANCY INDEX

CA 125 estimation
Menopausal status
pre menopausal score = 1
post menopausal score= 3
Ultrasound score
Multi locular, solid areas, bilateral, ascitis, intra ab
mets.
if 0 or 1 score = 1
if 2-5
score= 3
RMI = CA125 x M x U

Stage
4

Growth involving one or both ovaries with

distant mets.

PRIMARY
- Primary cytoreduction
- TAH, BSO, OMETECTOMY,
WASHINGS, BOWEL SURGERY
- Optimal debulking: less
than 2 cm residual tumors
- Staging once histology is
available
- If confined to ovary and
young age, conservative
surgery
CHEMOTHERAPY
Indication stage 1c and
above
Platinium based
- Taxol
- 6 cycles at 3 weekly
intervals
- Monitoring:
examination
CA125
FBC, U&E

MALIGNANT EPITHELIAL OVARIAN TUMORS

MANAGEMENT
SURGICAL
INTERVAL DEBULKING
SECOND LOOK
SURGERY
- Alternative to primary surgery
- Assess response to
medically unfit
chemotherapy
large ascitis
- Plan future
severe malnutrition
management
- 3 cycles of chemotherapy surgery 3
- Only in research
more cycles of chemotherapy
context.
- Aim : to improve patient condition
less extensive surgery to achieve
optimal debulking
- May improve survival
FOLLOW UP
How aggressive?.
Three monthly for one year
then six monthly then yearly
History, examination and
CA125
Imaging if recurrence is
suspected clinically or by
CA125

PALLIATIVE SURGERY
- Removal of intestinal
obstruction
- Survival is very poor
- Quality of life
considerations

SCREENING
Life time risk is 1%
5% of tumors are genetic
History of breast cancer increases risk by factor of 2
History of ca ovary increases the risk by factor of 3
One first degree relative affected: risk 2.7%
2 first degree relatives affected : risk is 13%
If BRCA1 mutation carrier :
risk is 50%
Problems :
- no pre-cancerous stage
- unknown natural course
TVS AND CA125 ON YEARLY BASIS
ONGOING STUDY TO EVALUATE THIS.