Ovarian tumor

Question 1

Classification of benign ovarian tumor

Answer 1

• Benign functional cysts: originate from normal ovarian follicle
  (eg: follicular cyst, corpus luteal cyst, theca luteal cyst)
• Benign epithelial tumours: originate form ovarian surface epithelium; increase with age and most common in peri-menopausal women
  (eg: benign serous/ mucinous cystadenoma, clear cell tumour)
• Benign germ cell tumour: originate from totipotent germ cells; 50% of ovarian tumours in 20s age group
  (eg: benign teratoma)
• Benign sex cord stromal tumour: originate from gonadal stromal/ connective tissue stroma
  (eg: fibroma, thecoma)

Question 2

Complication of benign ovarian tumor

Answer 2

” THIN RIM”

• T: Torsion
• H: Hemorrhage
• I: Infection
• N: Necrosis
• R: Rupture
• I: Impaction
• M: Malignant change

Question 3

Risk factor for ovarian tumor

Answer 3

• Nulliparity
• Early menarche
• Late menopause
• Endometriosis
• Cigarette smoking
• Family hx: BRCA1/ 2
• HPNCC

Question 4

Symptoms of ovarian tumor

Answer 4

• Persistent pelvic and abdominal pain
• Abdominal swelling
• Constitutional symptoms: Weight loss
• Compressive symptoms (eg: constipation, urinary retention/ frequency)
• Backache
• Irregular bleeding

Question 5

Investigation for ovarian tumor

Answer 5

• UPT: to exclude pregnancy
• FBC: anemia
• LFT: exclude liver mets
• Renal profile: compress ureter lead to hydronephrosis
• Tumor marker: CA 125 (increase in 80% of epithelial ovarian cancer)

> Imaging
- Ultrasound abdomen and pelvis: detail of mass, any feature suggestive of malignancy

Question 6

Features suggestive of ovarian malignancy in ultrasound

Answer 6

• Multilocular cyst
• Bilateral
• Thick septae
• Thick irregular capsule
• Solid area (mixed echogenicity)
• Papillary projection
• Ascites

Question 7

Staging of ovarian Ca

Answer 7

FIGO staging

• Stage 1: limited to ovaries
  1a: limited to 1 ovaries
  1b: limited to 2 ovaries
  1c: either 1a/ 1b + tumor on surface of ovary/ with capsule rupture/ ascites positive for tumor cells
• Stage 2: limited to pelvis
• Stage 3: limited to abdominal peritoneum/ positive retroperitoneal/ inguinal LN
• Stage 4: involving 1 or both ovaries + distant metastases

Question 8

Management of epithelial ovarian cancer

Answer 8

• 1a: unilateral salpingo-oophorectomy
• 1b: TAHBSO + omentectomy
• 1c and above: TAHBSO + omentectomy + LN clearance + chemotherapy

Question 9

Classification of Pap smear result

Answer 9

“Bethesda Classification”

• I: Non-diagnostic/ inadequate
• II: Benign (eg: infection)
• III: Atypia lesion of undetermined significance
• IV: LSIS
• V: HSIS
• VI: SCC