Ovarian Tumour (Benign and Malignant)

Overview

Most common histological subtype is epithelial ovarian cancer.
Risk Factors ⇒
- Older age (peak 74-79).
- Family History → mutations of BRCA1 and BRCA2 genes.
- Many Ovulations → early menarche, late menopause, nulliparity.
Protective Factors → parity (due to fewer ovulations), COCP, breastfeeding, hysterectomy.
Types of Ovarian Tumours
- Epithelial Cell Tumours (90%) → mostly malignant. Occur post-menopause.
  - Most are serous cystoadenomas.
- Germ Cell → mostly benign. Bimodal age distribution (15-20 yr olds > 65-70 yr olds). Teratoma is most common benign growth <30 yrs old. Raised AFP and hCG.
- Sex Cord Stromal → benign. Granulosa most common.
  - Granulosa → associated with endometrial hyperplasia. Produce oestrogen.
Krukenberg Tumour → metastases from gastric adenocarcinoma (signet ring cells on histology).

Making Diagnosis

Clinical Features

Often present with vague, non-specific symptoms.
- Abdominal distension and bloating.
- Feeling full or loss of appetite.
- Abdominal pain.
- Urinary symptoms.
<aside> 💡 Post-menopausal women with non-specific / IBS type symptoms.

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Pelvic mass.

Investigations

CA125 (BEST INITIAL TEST) Tumour Marker, if ≥35 IU/mL → 2ww referral and TVUSS.
- CA125 also raised in pregnancy, endometriosis and alcoholic liver disease.
Pelvic Ultrasound.

<aside> 💡 RISK OF MALIGNANCY INDEX (likelihood of ovarian cancer) → menopausal status + ultrasound findings + CA125 level. If >200, classified as high-risk.

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<aside> 💡 Suspected Ovarian Cancer: carry out abdominal and pelvic examination. If examination normal, do CA125 (if this is ≥35 then urgent ultrasound scan of abdomen and pelvis should be arranged). If examination abnormal and reveales ascites and/or a suspicious abdominal/pelvic mass, should refer to gynaecology under two week wait pathway (no need for other investigations).

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Definitive diagnosis → Histopathology.
If <40 yrs old + complex ovarian mass → AFP and hCG for possible germ cell tumour.