Ovarian tumors – cysts, cysts, tumors. What is the diagnosis of an ovarian tumor?

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Ovarian tumors are cancerous and non-cancerous changes that occur on the ovary. They are a serious gynecological problem that occurs in women of all ages. Ovarian tumors may indicate various diseases, both malignant lesions and benign tori. Ovarian cysts are usually filled with liquid or semi-liquid content.

Ovarian tumors

Ovarian tumors don’t always have to be a worst-case scenario, which is cancer. Occurring changes often indicate other conditions, such as fibroids and cysts. Tumors secrete hormones, mainly androgens and estrogens. On the basis of the produced hormones, the ovarian tumors are divided:

1. tumors that produce estrogens (pebbles, granuloma),
2. androgen producing tumors (steroid producing tumor, Sertoli and Leydig cell tumor) – these are mainly malignant tumors.

Tumors also secrete progesterone or cortisol (both malignant and benign).

Ovarian tumors can be cystic, solid, and mixed (cystic-solid). An ovarian cyst is defined as a structure filled with liquid or semi-liquid content, which always causes its enlargement. Character tumor accept both non-neoplastic and neoplastic changes of the ovary. According to research carried out as part of a nationwide social campaign “Diagnostics of the ovary”, almost 40 percent. of women did not visit the gynecologist in the last year. Unfortunately, many women still do not realize that ovarian cancer is the second most common cancer of the reproductive organs in our country. On the other hand, almost 140 die from this cancer in the world every year. women. Therefore, it is very important to systematically check the condition of the reproductive organs at the gynecologist, detecting the disease at an early stage gives a much better prognosis.

Noncancerous tumors of the ovaries

I. Functional cysts

Follicular and corpus luteum cysts are transient, functional cysts that reach six centimeters in diameter and persist for more than 60 days. If the functional cyst exceeds 6 cm in diameter and lasts more than three monthly cycles, it should be ruled out that it is a functional change.

II. Tecalutein cysts

These types of cysts can become very large. They can appear as a result of hormonal treatment – choriongonadotropin or clomiphene, or the presence of chorionic epithelioma. The absence of acute complications is an indication for symptomatic treatment or elimination of the cause, e.g. drug discontinuation.

III. Inflammatory cyst (ovarian-tubal cyst)

Inflammatory changes in the appendages can cause tumors up to 15 cm in diameter. Together with the tumor, there may be clinical and laboratory signs of inflammation.

IV. Torbiel endometrialna

The endometrial cyst appears due to periodic bleeding from the fragments of the uterine lining within the ovary. A frequent accompanying symptom of cysts are hard flat adhesions with adjacent organs. Inside the cyst there is a thick, old blood resembling chocolate in its consistency, hence their different name – “chocolate cyst”. The most common symptoms of endometrial cysts include: infertility, dysmenorrhea, painful periods, painful intercourse.

V. White body cysts

VI. Inclusion cysts

VII. Acidic cysts

These cysts are most often formed in young women from the remnants of developmental appendages. These cysts usually reach 3-4 cm in diameter, but they can also exceed 10 cm in size. Most of the cysts found in women are functional, benign, and do not develop into a malignant tumor. Sometimes, however, it is necessary to remove the cyst surgically (e.g. by laparoscopy). Vaginal ultrasound is necessary to detect cysts.

Ovarian tumors – general symptoms

Ovarian tumors (cysts) in their early stages of development usually do not show any symptoms. In women, changes are diagnosed accidentally during a routine ultrasound examination. Symptoms appear when the tumor grows large. Then in women you can observe:

1. pain in the ovary (where the cyst is located),
2. nausea,
3. vomiting,
4. irregular menstruation
5. spotting / bleeding between periods
6. sometimes the possibility of sensing Janik’s tumor at the site of pain,
7. headaches.

Ovarian tumors proper

Seventy percent of all ovarian malignancies are characterized by epithelial origin. The most common malignant neoplasms of the ovary are epithelial neoplasms, which account for about 85% of all neoplastic tumors. Gonadal neoplasms account for about 5-10% of ovarian malignancies, germinal neoplasms – about 5%, and non-ovarian-specific neoplasms account for about 1%. Ovarian cancer is a very cunning disease that does not cause any disease symptoms for a long time, which is why it is very often diagnosed too late. If in the patient’s family one of the women suffered from ovarian cancer, it is worth performing genetic tests for the presence of mutations in the BRCA 1 and BRCA 2 genes. In addition, you should visit the gynecologist at least once a year and perform cytology and ultrasound of the abdominal and vaginal cavities.

Causes of a malignant tumor of the ovary

While the specific cause of ovarian cancer is still unclear, there are certain factors that increase your risk of developing it:

1. ovarian or breast cancer in family members
2. childlessness and infertility,
3. mutation of the BRCA1 and BRCA2 genes,
4. disturbed hormonal balance janikó,
5. having a first child after the age of 35.

Ovarian tumors and fibroids

Ovarian fibroids is a very rare neoplasm, accounting for about 1% of all benign ovarian lesions. Ovarian fibroids are much less common in contrast to uterine fibroids, which are the most common malignant neoplasm in women. What are the causes of fibroids? They are formed from smooth muscle tissue and are usually found in pre- or postmenopausal women. The lesions are usually located on one ovary and are not of a significant size. In some cases, fibroids also affect women of childbearing age and even little girls.

It may happen that the fibroids will not show any symptoms and their diagnosis is made only with the help of a histopathological examination. In women with this type of tumor, the ovary is observed

1. fluid in the pericardium
2. stomach pain,
3. pleural fluid
4. ascites.

Treatment of less advanced fibroids (especially in young women) involves the removal of the diseased ovary and the fallopian tube in order to preserve the woman’s ability to procreate. When ovarian myoma is additionally accompanied by uterine myoma, a hysterectomy should be performed, i.e. removal of the body and cervix together with the ovary and fallopian tube. The uterus is preserved by more and more modern methods in the form of embolization and laparoscopy.

Ovarian tumors – risk factors, development and symptoms

The initial symptoms of an ovarian tumor are usually sparse and non-specific, sometimes absent. Clear symptoms usually appear late, when the tumor size exceeds 7 cm. Patients most often complain of abdominal discomfort, abdominal fullness, pressure, abdominal distension, periodic abdominal or pelvic pain. These symptoms are known as ovarian tumor abdominal mask. Pressure on the surrounding organs can cause problems with passing stools and urine. When the tumor is 10-15 cm in diameter, it can be felt through the abdominal wall and increases the circumference of the abdomen. In the case of malignant neoplasms or benign neoplasms (e.g. ovarian fibroma), ascites also appear. The large size of an ovarian tumor may cause shortness of breath, varicose veins and edema of the lower limbs. Cachexia is a late symptom of malignant ovarian tumors. Another condition associated with ovarian tumors is abnormal vaginal bleeding.

Approximately 5–6% of ovarian tumors are hormonal. Sodium and pebble produce estrogen which contributes to abnormal vaginal bleeding, abnormal growth of the endometrium, and the formation of fibroids. Women, especially older ones, look much younger if they have ovarian granuloma than their peers. The ovarian testis and the lipid cell tumor produce androgens, which causes menstruation to stop and male features (e.g. abnormal hair, voice deepening). A tumor called a goiter of the ovary can secrete thyroid hormones and lead to hyperthyroidism. In turn, ovarian carcinoid produces serotonin, and chorionic epithelioma of the ovary produces the hormone choriongonadotropin (HCG).

Diagnostics of ovarian tumors

The basic examination in diagnosing malignant changes in the ovary is an ultrasound examination, on the basis of which it is possible to determine whether the lesion is malignant or benign. Other imaging tests, such as computed tomography, PET (positron photon emission tomography), and magnetic resonance imaging are also helpful. In addition to imaging tests and medical history, blood laboratory tests are of great importance.

The basic determination performed routinely is the concentration of Ca-125 tumor antigen. This marker may also be elevated for other reasons, although its sensitivity in the diagnosis of ovarian cancer is very high. The determination of this marker is also performed during the monitoring of the disease treatment process. To increase the effectiveness of the assessment of malignancy of the detected neoplasm, an algorithm called ROMA was developed. The ROMA test consists of measuring Ca-125 and HE4, the concentration of which increases in the blood when epithelial ovarian cancer is present. The HE4 marker is usually used to monitor the treatment process and detect possible relapse of the disease.

The use of the ROMA test increases the sensitivity and specificity of the patient’s classification to the group of high or low risk of malignancy of the lesion located in the ovary, with an important distinction for pre- and postmenopausal women.

The diagnosis of ovarian tumors is very important because early detection of changes determines the further treatment success and prognosis. It is worth remembering about performing preventive examinations.

Treatment of ovarian tumors

Treatment of ovarian tumors mainly involves surgery, after which the prognosis is usually good (except for malignant tumors). Any woman diagnosed with an ovarian tumor should receive the best possible medical care. The cooperation of the gynecologist and endocrinologist is often necessary (sometimes even the intervention of a psychologist is needed) /

Women with ovarian cancer that secretes androgens often undergo antidepressant treatment. This is especially true for women in whom the ovary and the entire fallopian tube were removed due to the large size of the tumor.

Ovarian tumors and complications

Complications of acute ovarian tumors that should undergo surgical intervention include:

1. tumor stalk torsion,
2. tumor rupture
3. bleeding inside or outside the tumor
4. clamping and entrapment of the tumor in the recto-uterine cavity (Douglas sinus).

Another complication is tumor suppuration. In turn, a long-lasting benign tumor may develop into a malignant tumor over time.