Ovarian tumor

축소 확대

Ovarian tumors and non-neoplastic(functional) cyst

If there is a lump in ovary, not everything is cancer. In particular, 80~85% of ovarian tumors of women with the age of 20~44,
which is the reproductive age are benign. However, it should be examined whether it has the possibility of malignancy through
diagnosis and ultrasound test.

 

In case of more than 8 cm of tumor size, solid components or dissepiments, or no decrease in size through observation,
surgery is recommended.

 

However, unlike women with childbearing age, it is the principle to perform the surgery regardless of size of ovarian tumor,
if it is found in postmenopausal women. The reason is that the possibility in which follicle cyst could be ovarian cancer is higher
than that in women with childbearing age.

 

Among lumps in ovary, functional ovarian cysts include follicle cyst, lutein cyst or theca lutein cyst, corpus luteum cyst, polycystic
ovarian disease and endometrioma.

Tumors which can occur in the ovary

Ovarian tumors consist of benign and malignant tumors(ovarian cancer).
Most of them are epithelial tumors originating from epithelium and germ cell tumors appear in adolescents or young women.

  • Epithelial tumors : It consists of serous tumors, mucinous tumors, endometrioid tumors and clear cell tumors.
    It can be divided into benign and malignant tumors based on extent of differentiation.
  • Germ cell tumor : It is common in young women and teratoma is the most common. Even though the frequency is very low
    compared with benign, dysgerminoma is the most common as malignant germ cell tumor.

Treatments of ovarian benign tumors

  • Most cases of benign tumors require surgical treatment.
  • Hormone suppression therapy is additionally performed in case of ovarian endometrioma.
  • If it is small or it is the case of functional cyst, follow-up can be observed.

Ovarian Cancer

Ovary has various functions such as creation /secretion of ovarian hormones and facilitation of growth of egg.
Therefore, it is the place where several kinds of tumors can occur. Malignant tumor is called ovarian cancer.

Causes

The cause of ovarian cancer is not known yet, but factors increasing the possibility to induce the ovarian cancer include the
presence of patient with ovarian cancer in the family, age of 40 or higher(in particular, age of 60 or higher), women with infertility
or no experience of delivery or patients with obesity, breast cancer, endometrial cancer or colorectal cancer.

 

The possibility of occurrence of ovarian cancer in women with mother or sister who died of ovarian cancer is 18 times as high as
women without family members who died of ovarian cancer. Some family trees have ovarian cancer, breast cancer and
colorectal cancer together.

 

However, 95% of patients with ovarian cancer do not have family tree. It has been reported that the risk is reduced if oral
contraceptives are taken for a long time.

Clinical Symptoms

Since ovary is located within the abdominal cavity, early ovarian cancer progresses without symptoms. Because of that,
70% of ovarian cancer is found out when it is developed to stage 3.

 

Main symptoms of ovarian cancer are pain(57%), abdominal distention(51%) and vaginal bleeding(25%). Besides, vague
gastrointestinal disorders, vague sense of abdominal abnormality, digestive disorders, mild anorexia, premenstrual tension,
severe breast swelling, accompanied profuse menstruation and functional bleeding are included.

 

Symptoms such as irregular vaginal bleeding to identify the cause are mostly not associated with ovarian cancer.

 

As such, since there is no early symptom, it is recommended that all women should take the regular cervical cancer screening
once a year. If combination of transvaginal ultrasonography and blood test(tumor markers, CA 125) is made upon diagnosis of
cervical cancer, it will be helpful for early diagnosis.

Diagnosis

Regular pelvic examination, tumor associated antigen, ultrasonography, computed tomography(CT) or magnetic resonance
imaging(MRI) and cytology on abdomen can be helpful for diagnosis, but final diagnosis can be made by biopsy through surgery.

 

It can be classified into stage 1(tumor is confined to ovary), stage 2 (it is spread to the pelvic beyond ovary), stage 3 (it is spread to
abdominal cavity beyond ovary and pelvic or lymph node metastasis) and stage 4 (it is accompanied by peritoneal metastasis
beyond abdominal cavity) based on the extent of spread of tumor through surgical findings.

Treatments

  • Surgery(cytoreductive surgery)

    • The first step of treatment for ovarian cancer is to remove tumor area as much as possible by surgery.
    • Other treatments may be combined based on size, growth rate of tumor, degree of cancer progression upon
      diagnosis, kinds of cancer cells and patient’s systemic condition.
    • For women with childbearing age, the treatment plan can vary based on whether she want to be pregnant.
    • If the tumor is found at the very beginning, only ovaries with tumors can be removed, but the ovaries and
      uterus on other side can be preserved.
    • However, in most cases, in order to prevent the spread of cancer, both sides of the ovaries and uterus
      will be resected.

  • Chemotherapy

    • Except the very early stages, chemotherapy may be given after the surgery in most cases.
    • It is usually administered 6 times or 3 times every three weeks.
    • Anticancer drugs can be administered through insertion of tube during the surgery rather than
      intravenous injection.

  • Radiation therapy

    • In ovarian cancer, radiation therapy is not commonly used.

  • Treatment of borderline ovarian cancer

    • Many cases in borderline ovarian cancer belong to stage 1. The principle in women who do not want to be
      pregnant is to perform total vaginal hysterectomy and bilateral salpingo-oophorectomy. However, women
      who want to be pregnant can undergo ovarian cystectomy or unilateral oophorectomy.
    • In the stage 2 or later, the surgery to remove tumor as much as possible is performed and chemotherapy
      can be performed after the surgery.

Follow-up after treatment

  • After treatment, the effect of the treatment is determined through tumor markers(CA 125, etc.) test and CT/MRI.
  • In some cases, more precise treatment effect can be determined through a second surgery.
  • If disease still remains, additional surgery or chemotherapy is added.
  • If disease does not remain any longer according to determination of treatment result, follow-up is made every three months.
    The recurrence is determined through physical examination and tumor markers test.

Survival rate

  • 5 year survival rates of ovarian cancer based on stage are 76~93% in stage 1, 60~74% in stage 2, 23~41% in stage 3 and
    11% in stage 4.
  • Survival rate of borderline ovarian tumor is 95% and 90% for 10 years and 20 years, respectively.