VERIFIED CONTENTAuthor: Katarzyna Wieczorek-Szukała, MD, PhD, medical biotechnologist, Medical University of Lodz

Ovarian tumors are detected in women of all ages and may be associated with hormonal disorders, genetic predisposition or menopause. Ovarian tumor is defined as both malignant and benign changes occurring within the structure of the ovary. Although the diagnosis of an ovarian tumor may evoke negative associations and fears in us, it should be remembered that most of these types of changes are not cancerous.

Ovarian tumorsencompass very diverse types of lesions originating from the different tissues that make up this organ. They can be bothnon-cancerousandcancer . Regular visits to the gynecologist and prophylaxis of the condition of the reproductive organs should be an obligatory point of care for the he alth of every woman. Unfortunately, in Poland, the frequency of gynecological examinations leaves much to be desired. This is probably one of the reasons why ovarian cancer is still one of the highest death rates in our country. Many women forget that early detection of most tumors results in more effective treatment.

How do ovarian tumors develop?

The ovary has a layered structure. It is covered with epithelium on the outside, while its inside is made up of cortical and spinal parts, along with blood vessels and nerves. The core part contains the characteristic cavity cells that produce steroid hormones - mainly androgens.

The cortical part of the ovary contains oocytes, or ova, which are released each month during ovulation. With age and the occurrence of hormonal disorders, larger or smaller tumors may form in this area - the so-called cysts.

Usually such changes are spontaneously absorbed, but sometimes they may undergo further transformations, which is the beginning of the neoplastic process.

In terms of structure, ovarian tumors can becystic, solid, or mixed (cystic-solid) .

Non-cancerous ovarian tumors (cysts)

Ovarian cysts can be divided intofunctional and non-functionalcysts. Functional cysts include follicular and cyststhe corpus luteum. Inactive ovarian cysts are endometrial cysts, dermoid cysts and polycystic ovary syndrome.

Functional ovarian cysts

Follicular cyst

In the ovaries of women of reproductive age, during the normal menstrual cycle, under the influence of follicle stimulating hormone (FSH), Graff's follicles increase and estrogen is released.

About halfway through the cycle - during ovulation - a mature Graaf follicle ruptures, releasing an egg. Sometimes, due to hormonal disorders, there is no signal for the physiological rupture of the follicle.

Over time, it will form a follicular cyst (cyst), i.e. a creature filled with a fluid that causes its gradual enlargement.

Corpuscular cyst

After ovulation, the so-called The corpus luteum, which inhibits the development of subsequent follicles during pregnancy.

If fertilization has not taken place, the corpus luteum degenerates and disappears. However, it may happen that this body, despite the lack of signals stimulating the further development of pregnancy, will not disappear, and a cyst will form inside it.

Functional cysts can reach a diameter of up to 6 cm and last up to 3 monthly cycles. After this period, they usually disappear spontaneously.

Inactive ovarian cysts

Endometrial cysts (also known as chocolate cysts)

These types of cysts can form during endometriosis, a chronic disease involving endometrial tissue in the uterus in other organs, such as the ovary.

During the menstrual cycle, the endometrium is regularly exfoliated, therefore, incorrect excretion of dead tissues will lead to the formation of bloody infiltrates and cysts that resemble chocolate in color.

Dermoid cysts (also called leathery)

Changes of a benign nature, originating from the ectoderm - the tissue that gives rise in the embryonic period, among others, to cuticle, nails, hair, teeth and glands.

These products, e.g. from the organism of an undeveloped fetus, can be found inside a dermal cyst.

Polycystic Ovary Syndrome (PCOS)

Systemic metabolic disturbances and abnormal hormone secretion prevent eggs from maturing properly or not being released into the fallopian tube during ovulation.

The vesicles that surround the eggs die and turn into small cysts. Hence, this disease is also called polycystic ovary syndrome.

Cancerous tumorsovaries

The ovary is made up of three types of cells: epithelial, granular and follicular, each of which may give rise to a malignant tumor. Ovarian tumors can be divided into:

  • neoplasms arising from epithelial tissue- which account for about 90% of all ovarian neoplastic lesions,
  • non-epithelial tumors- making up the remaining 10% of all ovarian tumors.

Non-epithelial neoplasms can arise from germ cells, stroma, or germ cells, among others. Examples of this type of tumors can be, for example:

  • tumor of the yolk sac,
  • reproductor,
  • grains,
  • pebble
  • Is a Sertoli cell tumor.

The most common form ofmalignant neoplasm of the ovaryis adenocarcinoma (Latin adenocarcinoma) of epithelial origin, often called ovarian cancer. This tumor can arise not only within the ovary itself, but also in the fallopian tubes, appendages and adjacent tissues.

Ovarian cancer is a very serious, complex disease and one of the cancers most often affecting women in Western Europe. The exact cause of ovarian cancer has not yet been understood, but a number of factors may increase the probability of its diagnosis.

The genetic aspect is of great importance, incl. the presence of neoplastic changes of the ovary or breast in women in the immediate family, as well as inheritance of mutations in BRCA1 and BRCA2 genes. The occurrence of mutations within the above-mentioned genes increases the risk of breast and ovarian cancer even several times, and unfortunately it increases with age.

Disrupted hormonal balance, problems with infertility, late motherhood and even obesity may also play a significant role in the etiology of ovarian cancer.

Symptoms of ovarian tumors

Most ovarian tumors, usually in the early stages of development, do not show any characteristic symptoms. Such changes are often diagnosed at random during an ultrasound examination.

Only when the tumor significantly increases in volume, reaching a diameter of more than 6-7 cm, patients may complain of a number of symptoms, such as:

  • pelvic pains
  • ascites - the accumulation of serous fluid in the peritoneal cavity
  • feeling of heaviness in the abdomen
  • irregular periods
  • bleeding / spotting during the cycle
  • sudden urge to urinate
  • constipation
  • flatulence
  • vomiting
  • neuralgia in the thighs, groin, lumbar region
  • painful intercoursesex
  • swelling of the lower limbs

Some ovarian tumors have their own hormonal function, so they can produce either estrogens (e.g., parenchyma and granuloma) or androgens (e.g., lipid cell tumors). Such activity will induce secondary hormonal disruptions.

However, these symptoms are not specific and may be caused by a number of unrelated conditions, therefore a detailed diagnosis becomes essential.

Diagnostics of ovarian tumors

The basic examination for ovarian tumors is a two-handed gynecological examination (through the vagina and rectum). It allows to define, among others tumor size, consistency (cyst or solid lesion) and ovarian mobility relative to other tissues.

It is also obligatory to perform an ultrasound examination, both transabdominal and transvaginal, which will more accurately define the nature of the detected lesion and its size.

Complementary, you can perform other imaging examinations - computed tomography or magnetic resonance imaging. Laboratory diagnostics, i.e. blood tests, play an important role in testing for ovarian cancer.

The routine test is the concentration of Ca-125 tumor antigen (elevated levels are characteristic of ovarian cancer), sometimes the level of HCG (human chorionic gonadotropin), AFP (alpha-fetoprotein) and LDH (lactate dehydrogenase).

It should be remembered, however, that the level of the above markers may also be increased in the case of a number of other diseases, e.g. endometriosis.

Treatment of ovarian tumors

Treatment of non-cancerous tumors, e.g. functional ovarian cysts, usually involves a periodic check-up by a doctor or the implementation of hormone therapy (most often birth control pills).

In the case of large or numerous cysts within one ovary, surgical removal is necessary. For benign lesions, a less invasive laparoscopic method is now recommended.

However, if it is suspected that the tumor may be malignant, the surgical procedure should include the removal of the uterus with appendages, the greater web and the appendix.

The exceptions in which sparing surgery is used include procedures in young women with a low stage of disease, who still want to have children.

After the operation, a histopathological assessment of the removed neoplastic tissue is performed. Only on the basis of the result of such examination, the treatment regimen for ovarian cancer is established.

Complementary to primary surgerycan be chemotherapy with cytostatic drugs (paclitaxel and platinum derivatives), administered in several cycles.

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Category:

Female diseases