ovarian tumor treatment

Benign and Malignant cysts and tumors of the ovary

Dr . Hayder Al Shamma’a

Treatment of ovarian cyst/tumor

Determine whether functional or neoplastic , and if neoplastic whether benign or malignant
Calculate the Risk of Malignancy Index ( RMI )
By measure CA 125 u/ml x US score x menopausal score
US score = (0 ,1, 3 )
for each of the following feature , one point
multilocular, bilateral, solid area, metastasis, ascitis
(0 for no US score, 1 for one US finding , 3 for 2 or more points)
Premenopause 1 , postmenopause 3

Example :- 25 years old , bilateral simple ovarian cyst, CA 125 = 20 u/ml

RMI = 20 x 1 x 1 = 20 → low risk ( cutoff value 200 )

Example 55 years , solid bilateral tumor , CA 125 = 90 u/ml

RMI = 90 x 3 x 3 = 810 high risk malignancy


Treatment of functional cyst
Functional cyst in asymptomatic woman ,(unilateral, simple cyst, thin wall, no ascitis less than 7 cm ) follow up for 6 weeks
Functional cyst will disappear

Treatment of ovarian neoplasm

Mainly surgical
Laparoscopy for benign ( low risk )
Laparotomy for malignant (high risk )

Treatment of benign ovarian cyst

Below age of 45 years
treated by cystectomy for small cyst
oopherectomy for large cysts
Above age 45 years
TAH + BSO

Treatment of malignant ovarian tumor

Staging +treatment
Stage I and II
TAH + BSO + omentectomy + para aortic lymphadenectomy + biopsy from diaphragm


For stage III and IV surgical staging + cytoreduction + chemo/radio therapy

Terminal care

Ascitis :- repeated aspiration, some times local chemotherapy
Intestinal obstruction:- subacute obstruction treated conservatively , surgical treatment indicated if the disease limited to a small segment of the bowel
Pain :- pain relief is an essential part of care and it is the least thing to do to the patient

Tumor like conditions

• Follicular cyst :- very common
When small not regarded as abnormal
Thin walled cyst lined by granulosa cells
Contain clear fluid
Rarely exceeds 5 cm
Asymptomatic secret estrogen
May cause endometrial hyperplasia
Occur when Graafian folicle not ovulate

Corpus luteum cyst:-

Bleeding inside corpus luteum
Increase it’s life span
Secret progesterone
Delay menstruation
Some time painful
Misdiagnosed as ectopic


Theca lutein – graulosa lutein cysts
Bilateral
Occur when excessive stimulation of the ovaries by gonadotrophins
From H- mole secret hCG
From Clomiphene treatment or FSH
Disappear when gonadotrophins stoped

Ovarian tumors in pregnancy

Occur in 1/1000 pregnancy
5% malignant
10% functional
85% benign , dermoid and cystadenoma

Management

Malignant → treat irrespective to pregnancy
Benign → treat in 2nd trimester

Thank you