Ovarian Neoplasms | Types, Symptoms, and Treatment

Introduction: Why does understanding ovarian neoplasms matter?

“Ovarian neoplasms” refers to a spectrum of masses that may be benign or malignant. These lesions can remain silent for years and be found incidentally on exam or imaging, or they may present with warning signs like pelvic pain, bloating, abnormal bleeding, weight changes, or a sense of abdominal pressure.

The key concern is that some of these masses can be malignant and life-threatening, whereas early detection can prevent progression and, in many cases, preserve fertility.

Classification by tumor behavior

Benign neoplasm

Masses confined to the ovary that grow slowly and do not invade nearby tissues or spread to distant organs. They are usually treated with straightforward surgery and have an excellent prognosis.

Malignant neoplasm

Tumors capable of invading surrounding tissues and metastasizing to other organs. Ovarian cancer is often diagnosed at an advanced stage and typically requires complex management, including surgery and chemotherapy.

Types of ovarian neoplasms by tissue of origin

1. Epithelial tumors

   – Benign: Serous cystadenoma, mucinous cystadenoma

   – Malignant: Serous carcinoma, mucinous carcinoma, endometrioid carcinoma

   This is the most common group in adult women.

2. Germ cell tumors

   – Benign: Mature teratoma (dermoid cyst)

   – Malignant: Dysgerminoma, yolk sac tumor

   Often occur in adolescents and young women and may present with rapid abdominal enlargement.

3. Sex cord–stromal tumors

   – Examples include fibroma, granulosa cell tumor, Leydig cell tumor

   Some secrete hormones and can cause symptoms of excess estrogen (abnormal uterine bleeding) or androgens (virilization).

Clinical symptoms

Presentation depends on the type and size of the mass:

• Pelvic pain or pressure due to stretching of the ovarian capsule or compression of adjacent organs
• Bloating or increased abdominal girth from ascites or tumor growth
• Changes in bowel or urinary habits, such as constipation or urinary frequency from pressure effects
• Abnormal uterine bleeding, especially with hormone-producing tumors
• Unexplained weight loss or gain, which may suggest malignancy
• Hormonal signs, such as postmenopausal bleeding or precocious puberty

Many of these symptoms are nonspecific and can mimic other conditions, which underscores the need for medical evaluation and follow-up.

Risk factors

• Age over 50 years (malignancy is more common)
• Family history of ovarian, breast, or colon cancer
• BRCA1 or BRCA2 mutations or Lynch syndrome
• Nulliparity (no full-term pregnancy)
• Endometriosis (increased risk for certain epithelial tumors)
• Prolonged, unsupervised hormone therapy

Diagnostic approach

1. Pelvic examination to assess mass size, consistency, and tenderness
2. Transvaginal ultrasound as the first-line tool to characterize cystic, solid, or complex features
3. Doppler ultrasound to evaluate tumor vascularity (often increased in malignancy)
4. MRI or CT scan for staging or assessing spread to other regions
5. Tumor markers:
   •    CA-125 for epithelial malignancies
   • AFP, β-hCG, LDH for germ cell tumors

6. Diagnostic laparoscopy or laparotomy with biopsy for definitive diagnosis

Treatment

Benign neoplasms

• Fertility-sparing surgery whenever possible (especially in young patients)
• Periodic postoperative ultrasound follow-up

Malignant neoplasms

• Comprehensive surgery, often including removal of the uterus, ovaries, fallopian tubes, and omentum, with staging procedures
• Systemic chemotherapy, most commonly carboplatin plus paclitaxel
• Targeted therapy (such as bevacizumab) or immunotherapy in selected cases
• Supportive care for pain control, nutrition, and psychological support

Prevention and screening

Population-wide screening is not recommended. In high-risk individuals, consider:

• Periodic transvaginal ultrasound
• CA-125 monitoring
• Risk-reducing salpingo-oophorectomy after completion of childbearing

Clinical scenarios

Case 1: A 19-year-old with sudden abdominal pain is diagnosed with a mature teratoma and undergoes successful, ovary-sparing surgery.

Case 2: A 55-year-old with ascites and elevated CA-125 is diagnosed with stage III serous carcinoma and treated with surgery followed by chemotherapy.

Case 3: A 40-year-old with abnormal bleeding is found to have a granulosa cell tumor and undergoes tumor resection.

Conclusion

Ovarian neoplasms range from benign cysts to aggressive cancers. Symptoms are often vague and overlap with other conditions. Awareness, targeted surveillance in high-risk groups, and early medical evaluation can significantly improve the chances of successful treatment.

References

1. Berek JS, et al. Berek & Novak’s Gynecology. 2020.
2. National Cancer Institute – Ovarian Cancer Overview.
3. WHO Classification of Tumours of Female Reproductive Organs, 5th Edition.
4. UpToDate – Epithelial ovarian carcinoma: Clinical features and diagnosis.