What are the characteristics of ovarian tumors?
1. Ovarian tumors are common gynecological tumors that can develop at various ages, but the histological types of the tumors will be different. Ovarian epithelial tumors are more common in women aged 50-60 years old, while ovarian germ cell tumors are mostly seen in young women under 30 years old. Ovarian malignant tumor is one of the three common malignant tumors of female genitalia.
2. Ovaries are located in deep pelvic cavity, early lesions are not easy to detect, once symptoms appear most of them are late and should be highly alert. In the past 20 years, due to the application of effective chemotherapy program, the treatment effect of malignant germ cell tumors has improved significantly, and the mortality rate has decreased from 90% to 10%; however, the treatment effect of ovarian malignant epithelial tumors has not been improved, and the 5-year survival rate hovers at 30%-40%, and the mortality rate ranks first in gynecological malignant tumors. Ovarian malignant epithelial tumor has become a major tumor that seriously threatens women’s life and health.
The ovary is a small but complex tissue, and it is the site with the most types of tumors in all organs of the body; ovarian tumors have many histological types and are classified as benign, junctional and malignant. The ovary is also a common metastatic site for malignant tumors of gastrointestinal tract, breast cancer, endometrial cancer, etc.
How are ovarian tumors classified histologically?
1. Epithelial tumors
Epithelial tumors account for 50%-70% of primary ovarian tumors, and their malignant types account for 85%-90% of ovarian malignant tumors. It originates from the germinal epithelium on the ovarian surface, which is derived from the primitive corpora cavernosa epithelium and has the potential to differentiate into various mullerian epithelium. If it differentiates to fallopian tube epithelium, it forms plasma tumor; to cervical mucosa, it forms mucinous tumor; to endometrium, it forms endometrioid tumor.
2.Germ cell tumor
They account for 20%-40% of ovarian tumors. Germ cells originate from endodermal tissues other than gonads and can mutate and form tumors during their occurrence, migration and development. Germ cells have the function of generating multiple tissues. Undifferentiated ones are asexual cell tumors, embryonic pluripotent ones are embryonal carcinomas, differentiation to embryonic structures are teratomas, differentiation to extra-embryonic structures are endodermal sinus tumors and choriocarcinomas.
3.Interstitial tumor of sex cord
It accounts for about 5% of ovarian tumors. Interstitial tumors of the sex cords originate from the mesenchymal tissue of the primitive body cavity and can differentiate into both sexes. The sex cords differentiate to the epithelium to form granulosa cell tumor or supporting cell tumor; to the mesenchyme to form follicular membrane cell tumor or mesenchymal cell tumor. These tumors often have endocrine function, so they are also called functional ovarian tumors.
4. Metastatic tumors
They account for 5%-10% of ovarian tumors, and their primary sites are mostly in the gastrointestinal tract, breast and reproductive organs.
How to treat ovarian tumor?
1.If the mass is less than 5cm in diameter, it is suspected to be ovarian tumor-like lesion, so it can be observed for a short time.
2.Once diagnosed as ovarian tumor, it should be treated surgically. The surgical method and scope of surgery should be decided according to the patient’s age, fertility requirements and the condition of the opposite ovary.
For young patients with fertility requirements, unilateral benign tumor should be treated by ovarian cyst exfoliation or adnexal resection on the affected side, preserving normal ovarian tissue and the opposite normal ovary as much as possible; even for bilateral benign cysts, cyst exfoliation should be performed to preserve the endocrine function and reproductive function of the ovary by preserving normal ovarian tissue. The preserved ovarian tissue, like normal ovaries, still has the potential to become diseased.
In perimenopausal women, unilateral adnexal resection or total hysterectomy and double adnexal resection is performed. After hysterectomy, menstrual and reproductive functions will be lost, and after double adnexal resection, menopausal symptoms will appear, and hormone replacement is needed if necessary.
3.Inspect the cut tumor during ovarian tumor surgery, and after distinguishing benign and malignant with naked eyes, the tumor should be sent for intraoperative frozen section examination (i.e. quick examination) immediately, and the scope of surgery should be decided according to the results of quick examination. If the tumor is large or suspected to be malignant, gauze pads should be used to protect the incision from implantation when removing the mass, and the tumor should be removed as completely as possible to prevent the flow of cyst fluid and implantation of tumor cells in the abdominal cavity. In case of huge ovarian cysts, fluid can be released by puncture first and then removed after the tumor volume is reduced.
How to follow up after treatment of ovarian malignant tumor?
Ovarian cancer is easy to recur and should be followed up and monitored for a long time.
1.Follow-up time
Once a month within one year after surgery; once every three months for two years after surgery; once every 4-6 months for 3-5 years after surgery depending on the condition; once a year for five years after surgery.
2.Monitoring content
Symptoms, physical signs, general and pelvic examination, ultrasound. CT or MRI examination if necessary. Tumor markers, such as CA125, AFP, HCG, estrogen, etc. can be used according to the condition.
What should be done if ovarian tumor is found after pregnancy?
Ovarian cysts combined with pregnancy are more common, but malignant tumors are rarely pregnant. Pregnancy combined with ovarian tumor is more dangerous than non-pregnancy. The majority of benign tumors are mature cystic teratoma and plasmacytoma (or mucinous) cystadenoma, which account for 90% of ovarian tumors in pregnancy, while the majority of malignant tumors are asexual cell tumors and plasmacytoma. In the absence of complications, pregnancy-associated ovarian tumors usually have no obvious symptoms. It can be detected by triage in early pregnancy. After mid-term pregnancy, it is not easy to detect, and the diagnosis should rely on medical history and ultrasound.
When ovarian tumors are detected in early pregnancy, the nature of the tumor should be clarified first. Unilateral, unicompartmental ovarian cysts less than 125 px in diameter found in early pregnancy may be physiologic cysts, and most of them disappear on their own after 14 weeks of gestation. There are also reports of flavin cysts up to 6-250 px in diameter during pregnancy that persist until the full term of pregnancy. In addition, the benignity and malignancy of the tumor can be inferred from the shape of the tumor (cystic, cystic solid, solid, with or without papillae inside the cyst), blood flow signal, presence of ascites, etc. as well as the detection of serum tumor markers as suggested by ultrasound.
In early pregnancy, the tumor may enter the pelvic cavity and cause miscarriage; in mid-term pregnancy, it may be easily complicated by torsion; in late-term pregnancy, if the tumor is large, it may lead to abnormal fetal position; in labor, it may cause rupture of the tumor; if the tumor is low, it may obstruct the birth canal and cause obstructed labor. The pelvic congestion during pregnancy may cause the tumor to increase rapidly and promote the spread of malignant tumor.
In early pregnancy combined with ovarian cysts, surgery should be performed after the third month of pregnancy to avoid inducing miscarriage. If the tumor obstructs the birth canal, a cesarean section should be performed after delivery and the tumor should be removed at the same time. If the tumor is diagnosed or suspected to be ovarian malignancy, surgery should be performed as early as possible, and the principles of treatment are the same as those for non-pregnancy.