Lorena Zepeda

OVARIAN TUMORS
 Follicular cyst

FUNCTIONAL Corpus luteum cyst

Theca lutein

OVARIAN MASSES Tubo ovarian abscess

INFLAMMATORY

Benign

NEOPLASTIC Borderline
Malignant

Endometrioma
OTHERS Enlarged PCO
Parovarian cyst
 EXAMINATION
AGE!
Laterality
Cystic Vs solid

PHYSICAL

What to look for?

Mobile Vs fixed
Smooth Vs irregular
Ascites
Cul-de-sac nodules
Rapid growth rate
 AGE GROUP
? Menarche Menopause
 COMMON OVARIAN TUMOURS BY AGE GROUP

Pre Peri Post

Infancy Adolescent Reproductive
pubertal menopausal Menopausal

1. Functional
cyst
Functional cyst
Functional cyst Functional cyst
Epithelial
ovarian tumor
Neoplastic
ovarian tumor

Germ cell Germ cell

2. tumor tumor
Germ cell tumor Dermoid Functional cyst Functional cyst

3. Epithelial tumor Epithelial tumor Mets

WHAT TO DO?
 1 ST STEP
SIMPLE VS COMPLEX BY US
ASSESSMENT
MI
Malignancy risk
interpretation
MI <5 = ~0.3%
MI 8. = ~84%
SE 98% SP 80%
PPV 40%, NPV 99%
SIMPLE ULTRASOUND-BASED RULES FOR THE
DIAGNOSIS OF OVARIAN CANCER.
 Ovarian mass in reproductive age group

<5 cms
USG 5 cms
+ asymp
Likely physiologic
Simple or complex?
No follow up needed.

Cystic Complex,
& 5-7cm solid,
Annual suspicious
observation
Persistence/
progression Surgery
RCOG 2011
 OVARIAN MASS IN CHILDHOOD:

Solid or complex cyst

USG Simple cyst
Observe and reassess
MRI + tumor markers

High suspicion Low suspicion

of malignancy of malignancy

Laparotomy Laparoscopy

Malignant : Frozen section Benign :

Oophorectomy Cystectomy
and staging
TUMOR MARKER IN OVARIAN MASSES
OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN:
Post menopausal gonad atrophies Asymptomatic incidence:
to a size of 1.5 X 1 X 0.5cm on 1.5% by pelvic examination
average and they shouldnt be 3.3% to 14.5% by USG.
palpable on pelvic examination.

Presence of palpable ovary Causes:

10% functional
must alert the possibility of
90% neoplastic
an underlying malignancy.
 TO TAKE HOME INFO ;)
Simple, unilateral, unilocular ovarian cysts, less than 5 cm in diameter, have a low risk of
malignancy. It is recommended that, in the presence of a normal serum CA125 levels, they
be managed conservatively.

Aspiration is not recommended for the management of ovarian cysts in postmenopausal

women.

It is recommended that a risk of malignancy index should be used to select women for
laparoscopic surgery, to be undertaken by a suitably qualified surgeon.

It is recommended that laparoscopic management of ovarian cysts in postmenopausal

women should involve oophorectomy (usually bilateral) rather than cystectomy.
COMPLICATIONS OF A MASS
Torsion
Intracystic hemorrhage
Infection
Rupture
Pseudomyxoma peritonei
Malignancy
 OVARIAN
NEOPL ASMS
A Q U I C K LY O V E R V I E W
5th mcc female cancer

1 in 73
women will develop ovarian cancer in her lifetime
 TYPES OF OVARIAN TUMORS
Benignant
Borderline
Malignant

90% epithelial ovarian cancer

7% sex cord-stroma ovarian cancer
3% germ cell ovarian cancer
STAGING
 NEW SCORES
ROMA: Risk of Ovarian Malignancy Algorithm

The dual marker algorithm utilizing HE4 and CA125 to calculate a ROMA value

In patients with stage I and II disease, ROMA achieved a sensitivity of 85.3% compared
with 64.7% for RMI

MOORE ET AL, AJOG 2010

OVA 1:

FDA approved. Combination of 5 immunoassays

CA 125, transthyrettin, apo lipoprotein A1, transferrin, B2 microglobulin

Sensitivity : 93%, specificity: 43% PPV 42% NPV 93%

COMMUN ONCOL, 2010

TREATMENT