A benign tumor of the ovaries (ovarian tumor) means the non-cancerous cell growth in an ovary.
The ovaries are two organs of the female sexual apparatus, which are located to the right and left of the uterus and are connected to it via the fallopian tubes.
A benign tumor is not cancer, it rarely leads to death.
Normally, the benign tumors can be removed and they usually do not grow back.
A benign tumor does not penetrate into the surrounding tissues.
Benign tumor cells do not spread to other parts of the body.
A malignant tumor means cancer and is more serious than a benign tumor, it can be fatal.
Ovarian cancer is removed in many cases, but sometimes grows back.
A malignant tumor can infiltrate and damage the nearby organs and tissue structures.
The cancer cells can spread throughout the body via the lymphatic system or bloodstream.
The cells invade other organs and form new tumors that lead to organ damage. These metastases of cancer into distant tissue are called metastases.
Benign and malignant cysts
An ovarian cyst can form on the surface or in the ovary. A cyst contains fluid, but sometimes solid material.
Most ovarian cysts are benign.
The two ovaries are part of the female reproductive system. They produce eggs and two female hormones: estrogen and progesterone.
Benign ovarian neoplasms are usually not treated and can resolve spontaneously over time.
Ovarian tumors that turn out to be malignant can spread (metastasize) to other areas of the body, affecting nearby tissues and cells, the bloodstream, or lymphatic system.
The majority of tumoral masses on the ovary are benign.
Most often, a woman of fertile age has a simple functional ovarian cyst, which dissolves again at the next menstrual period.
In postmenopausal women, the most common ovarian tumor is benign cystadenoma. If there are no symptoms, ovarian tumors are usually detected during a physical examination or with the use of diagnostic imaging techniques. However, sometimes these tumoral masses cause pain and the patient turns to a doctor.
Contents
What causes ovarian tumors?
Tumors can form in the ovaries, as well as in other areas of the body.
Ovarian tumors can be divided into three groups:
- The epithelial tumors arise from the outer skin of the ovary. They are the most common ovarian tumors.
- The germ cell tumors arise from the female germ cells, the egg cells. They can be benign or malignant. The number of benign tumors predominates.
- The stromal tumors arise from the cells that produce the female hormones.
Doctors do not know exactly what causes ovarian cancer; however, some risk factors could be identified, including:
- age – women after menopause are particularly affected,
- smoking,
- Obesity
- childlessness or no breastfeeding at the mother’s breast (the contraceptive pill seems to lower the risk),
- fertility-promoting medicines (such as Clomid),
- Hormone therapy
- personal or familial case of ovarian, breast, or colon cancer (because the BRCA gene may increase the risk).
- According to the theory of continuous ovulation (Fathalla), the risk of ovarian tumor increases if there are many ovulations in a woman’s life (and consequently few pregnancies and short breastfeeding).
Classification
Primary ovarian tumors
Epithelial ovarian tumors (develop in women between 20 and 60 years of age): 60-70%
Serous ovarian tumors:
- serous, ovarian cystadenoma: 60% of serous tumors;
- serous, ovarian borderline cystadenoma: 15% of serous tumors;
- Serous, ovarian cystadenocarcinoma: 25% of serous tumors, the most common among malignant ovarian tumors.
Mucinous ovarian tumors: 20% of all ovarian tumors
- mucinous ovarian cystadenoma: 80% of mucinous tumors;
- mucinous, ovarian borderline cystadenoma: 10-15% of mucinous tumors. A borderline tumor is a tumor on the border between benign and malignancy;
- mucinous ovarian cystadenocarcinoma: 5-10% mucinous tumors.
Endometrioid ovarian tumors: 8-15% of all ovarian tumors
- ovarian cystadenofibroma, sometimes classified as a separate category rather than an epithelial tumor;
- ovarian adenofibroma: can be serous, mucinous, endometrioid, clear cell or mixed;
- ovarian cystadenocarcinofibroma: extremely rare.
Clear cell ovarian cancer: 5% of all ovarian cancers.
Brenner tumor: 2-3% of epithelial neoplasms of the ovary
- undifferentiated ovarian cancer: ~4% of all ovarian cancers;
- ovarian squamous cell carcinoma.
Germ cell tumors (usually develop in women under 30 years of age): 20% total
- ovarian teratoma: the most common benign primary tumor of the ovary;
- mature, ovarian teratoma;
- immature, ovarian teratoma;
- specialized ovarian atoms;
- Goiter ovarii.
Carcinoid ovarian tumors
- ovarian dysgerminoma.
Ovarian yolk sac tumor – endodermal sinus cell tumor.
Malignant mixed tumor of the ovary
- ovarian chorionic carcinoma: < 1% of ovarian tumors;
- pure, primary, ovarian chorionic carcinoma: extremely rare.
Germ cord tumors, stromal tumors: 8-10%
- fibrothecoma of the ovary: 5% of ovarian tumors;
- Ovarian fibroma: 4% of ovarian tumors.
Ovarian thecoma: 1% of ovarian tumors.
Sclerosing stromal tumor of the ovary: rare.
Sertoli-Leydig ovarian cell tumor: 0.5% of ovarian tumors.
Granulosa cell tumor: the most common among the malignant germ cord tumors
- juvenile granulosa cell tumor;
- adult granulosa cell tumor.
Mixed tumor: rare
Ovarian carcinosarcoma: < 1%
Other
Ovarian lymphoma Primary lymphoma of the ovary Secondary involvement of the ovary with lymphoma
Ovarian metastases
Krukenberg tumor
Other metastatic lesions on the ovary
What are the signs? Symptoms of ovarian tumors
At the initial stage, there are no symptoms; Ovarian tumors are therefore usually detected late, when they are advanced and already quite large, because the symptoms are vague and only appear over time.
Key symptoms include:
- fatigue,
- increase in size of the abdominal circumference,
- Weight loss
- bloated abdomen,
- pain in the ovaries,
- back pain,
- Disturbance and absence of menstruation (amenorrhea).
Most tumors on the ovary cause symptoms because they press on the adjacent structures; the consequences are frequent urination, a feeling of pressure in the pelvic area and constipation.
Due to the increase in size of the tumor, the abdomen swells. Metastasis in the upper abdomen causes nausea, heartburn, swelling of the abdomen, weight loss and anorexia.
Irregular vaginal bleeding may also occur.
Shortness of breath is a symptom of ascites (free fluid in the abdomen) or pleural effusion (accumulation of non-inflammatory fluid in the pleural cavity of the lungs).
Some tumors, which include the subgroups of stromal tumors of the germ strands, produce an excess of estrogen; the consequences are: early puberty, bleeding after menopause, prolonged menstrual bleeding (menorrhagia), acyclic bleeding lasting longer than 14 days (menometrorrhagia), absence of menstruation (amenorrhea), excessive growth of the uterine lining (endometrial hyperplasia/cancer) or cystic breast fibrosis.
Some subgroups of germ cord stromal tumors form androgens that lead to masculinization (virilization).
How is the medical diagnosis of a cyst or tumor in the ovary made?
The gynecologist or family doctor may feel a lump during a routine examination when palpating the abdomen.
Most ovarian tumors are benign, but in rare cases they can represent cancer.
Therefore, it is important to have the tumors controlled.
This is especially true for postmenopausal women, where there is a greater risk of ovarian cancer.
The following examinations are carried out if ovarian cysts and tumors are suspected:
Transvaginal ultrasound examination
In this examination, an image of the ovaries is made with the help of sound waves, which can be helpful for an early diagnosis. In the ultrasound image, the doctor can usually recognize the size and position of the cyst or tumor.
Further diagnostic imaging
Computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) are very precise examination methods. The doctor may horrify them to detect ovarian tumors and to get an idea of how they spread.
Hormone level. The doctor can check the concentration of certain hormones based on a blood test. These include luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol and testosterone.
Laparoscopy
This surgical technique is used in the treatment of ovarian cysts, where a thin, camera-equipped instrument is inserted through a small opening into the abdomen.
During the procedure, the surgeon may encounter cysts or tumors and take a small sample of tissue (biopsy), which is examined more closely for cancer.
CA-125 If the doctor
suspects that the tumor may be malignant, he may order a blood test to measure the tumor marker CA-125.
In ovarian cancer, it tends to be elevated in some women.
The analysis is mainly carried out in women over 35 years of age, in whom the risk of ovarian cancer is slightly greater.
If ovarian cancer is diagnosed, the doctor can use the diagnostic results to determine whether and how far the cancer has spread outside the ovaries.
In this way, the tumor is classified and assigned to a stage, due to which the doctor can determine the treatment and determine the life expectancy of the patient.
Assessment
Before menopause, a normal ovary is about 3.5 cm in size. After menopause, it shrinks to about 2 cm or less.
In a woman of fertile age, it is quite normal for the ovary to be palpable, but after menopause this is usually a sign of a tumor, but it does not have to be malignant.
Women of fertile age should make sure that everything is in order if the ovary has a diameter of more than 3.5 cm or has a firm consistency.
Differential diagnosis
The following diseases should be excluded by the doctor:
Functional cysts (not neoplastic in nature), for example, follicular cysts, corpus luteum cysts, lutein cysts.
Other causes of pelvic pain.
Polycystic ovary syndrome.
Endometrioma.
Malignant ovarian tumor.
In the intestinal area: colon cancer, appendicitis, diverticolitis (disease of the colon).
In the pelvic area: inflammation of the organs of the small pelvis, fallopian tube abscess, uterine tumor (eg fibroma), ectopic pregnancy, paraovarian cyst.
Neoplasms in the pelvic area, for example, retroperitoneal tumors, tumors in the small intestine and mesothelial tumors.
What to do? When does surgery have to be performed?
Many patients with simple ovarian cysts discovered during an ultrasound scan do not need treatment.
Women with simple, small ovarian cysts (smaller than 50 mm in diameter) usually do not need follow-up care, as these are usually physiological in nature and almost always disappear within three monthly cycles.
Women with simple ovarian cysts with a diameter of 50-70 mm in size should undergo an annual ultrasound check-up, women with large, simple cysts should undergo a more detailed examination using magnetic resonance or surgery.
A postmenopausal woman with a simple, persistent cyst, smaller than 5 cm, with normal levels of the tumor marker CA-125, can be checked regularly by ultrasound.
If ovarian cysts are persistent or increase in size, they are unlikely to be functional in nature; surgery may be necessary here.
Oral contraceptives
The birth control pill is not recommended because there is no evidence that taking it can cure functional ovarian cysts.
Surgical intervention
If conservative treatment is unsuccessful or the prerequisites for surgery are met, surgical treatment for benign ovarian tumors is usually very effective and has minimal effects on reproductive abilities.
Simple, persistent ovarian cysts larger than 5-10 cm, especially if they are symptomatic, as well as complex ovarian cysts are usually surgically removed.
In girls and young women, excision of the cyst (cystectomy) is definitely preferable to removal of the entire ovary (ovariectomy) in order to preserve maximum fertility.
Laparoscopic surgery for benign ovarian tumors reduces the risks of conventional surgical techniques.
The pain is less and the hospital stay is shorter than with an abdominal incision (laparotomy).
As far as relapses (relapses), fever and postoperative infections are concerned, there is no difference between the surgical methods.
If the tumor is inoperable, the oncologist may use palliative therapies (to reduce symptoms) or chemotherapy.
Ovarian rotation
Treatment usually begins laparoscopically by twisting the affected ovary and possibly by fixation on the pelvic walls.
Salpingoovariectomy is a surgical procedure in which one or both ovaries are removed along with the fallopian tubes. It may be indicated if there is severe vascular necrosis, peritonitis or necrotic tissue.
With a hemorrhagic cyst, surgery must be performed immediately.
If a malignant tumor is discovered, a laparotomy is recommended.
A gelatinous carcinoma or pseudomyxoma peritonei (a massive tumor cell-poor mucus formation in the entire abdominal cavity) is treated by surgical intervention in conjunction with chemotherapy.
Diet and nutrition
According to the principles of naturopathy, tumors can be cured by controlled fasting and a diet that lowers the acid in the blood.
It is recommended to eat plenty of fruits and vegetables, legumes, natural cereals, sodium bicarbonate and turmeric.
Avoid meat, eggs, milk and dairy products, fried foods and sugar.
A healthy diet is fundamental to prevent an ovarian tumor.
Complications
Rotation of the ovarian cyst is possible.
Bleeding (hemorrhage) is more common in tumors of the right ovary.
An ovarian cyst may burst.
Infertility is a possible consequence of ovarian tumors or their treatment.
What is life expectancy? Prognosis for ovarian tumor
Mortality depends on the type and size of the tumor, complications and the age of the patient.
In women of fertile age, most of the small ovarian cysts regress spontaneously.
Ovarian rotation: if surgery is performed within six hours of the onset of symptoms, the tissue can survive.
The prognosis for surgically removed cysts depends on their composition.
Is a cure possible? Five-year survival rate
- First stage (tumor limited to ovaries): 80-90%
- Second stage (spread to the egg tube or uterus and possibly ascites): 50-60%
- Third stage (spread or metastases within the pelvis and possibly affected lymph nodes in the groin or posterior peritoneum): 20-35%
- Fourth stage (metastases to the liver and other organs and pleural effusion): 10%
