Ovarian tumours

Question 1

What are the main types of ovarian tissue?

Answer 1

Ovaries consist of different kinds of tissue (epithelial, germ cells, and sex cord tissue

Question 2

What is the most common type of ovarian tumour and what is the peak incidence?

Answer 2

Epithelial tumour

Peak incidence is 50 to 60 yrs

Question 3

What are the risk factors of ovarian tumours?

Answer 3

(Genetic) BRCA1/BRCA2 mutation 
HNPCC syndrome 
Peutz-Jeghers syndrome
(Hormonal imbalance and menstrual cycle) 
Elevated number of lifetime ovulations (the contraceptive pill appears to have a protective effect)
Infertility/low number of pregnancies
Early menarche and late menopause
PCOS

Question 4

What are the sub-types of ovarian epithelial tumours?

Answer 4

Cystadenoma and Cystadenocarcinoma (most common) 
Endometrioid carcinoma (associated with endometriosis and endometrial cancer) 
Borderline ovarian tumors (increased epithelial proliferation and cellular atypia, without the invasive characteristics typical of malignant tumors)
Brenner tumor (Benign, similar to transitional cells of bladder)

Question 5

What is are germ cell tumours?

Answer 5

Tumours of ovary deriving from germ cells

Question 6

What are the sub-types of germ cell tumours?

Answer 6

Teratoma (can derive from any 3 germ cell layer. Dermoid cysts are the most common. These are benign and can differentiate into any tissue i.e. hair + teeth)
Dysgerminoma (most common form of malignant ovarian tumour in young women)
Yolk sac tumour of ovary

Question 7

What are the sub-types of sex cord tumours?

Answer 7

Estrogen producing: Granulosa cell tumor and Theca cell tumor (Benign, mostly affects post-menopausal women)
Androgen producing: Sertoli-Leydig cell tumour(Production of androgens → virilization, affects 30-40 yr olds)

Question 8

What are the clinical features of ovarian cancer?

Answer 8

Mostly asymptomatic
Abdominal pain and ascites
Disruption of menstrual cycle
Abdominal or pelvic mass

Question 9

How are ovarian tumours diagnosed?

Answer 9

Hypercalcemia due to paraneoplastic synthesis of PTHrP (parathyroid hormone related peptides)
(Tumour markers) Epithelial ovarian tumor: CA-125
Yolk sack tumor: alpha-fetoprotein
Non-gestational choriocarcinoma: beta hCG
Granulosa cell tumor: inhibin B
(Imaging) Transvaginal ultrasound

Question 10

What are some of the differential diagnosis for ovarian tumours?

Answer 10

Ovarian cysts
Endometriosis
Tubo-ovarian abscess
Ectopic pregnancy
Pelvic inflammatory disease

Question 11

What are the treatments for ovarian tumours?

Answer 11

(Surgery) Radical surgery including adjacent structures
(Chemotherapy) Recommeneded for all as adjunct, carboplatin polychemotherapy and antimitotics (e.g., paclitaxel)
Radiotherapy rarely used due to low tumour sensitivity and intraperitoneal

Question 12

How can ovarian tumours be prevented?

Answer 12

(Genetic risks) bilateral salpingo-oophorectomy if no future pregnancies are desired
Frequent screening (CA 125 and transvaginal ultrasound)
(Hormonal contraceptives) GnRH analogs, breast feeding, and tubal ligation (blocked or removed tubes)