Ovarian Soft Tissue Tumours

Ovarian Cyst Symptoms

Ovarian cysts are essentially inflamed or swollen pockets of fluid that develop on the surface or within the ovaries. Most are benign and may not present symptoms while others cause symptoms which can easily be noticed. Some of the more prevalent signs of ovarian cysts are:

• Pelvic Pain
• Bloating or Abdominal Fullness
• Menstrual Irregularities
• Pain During Intercourse
• Pain During Bowel Movements or Urination
• Frequent Urination
• Nausea or Breast Tenderness
• Difficulty Emptying the Bladder or Bowel

Ovarian Cyst Treatment

The management of ovarian cysts varies as to its type, size, symptomatology, and the patient’s menopausal status. Below is a broad look at possible treatments:

Watchful Waiting (Observation)

• Who it’s for: Incorporate into treatment plans women with benign cysts, small cysts, simple cysts or cysts that serve a functional role (most notably present in premenopausal women).

What it involves:

• No immediate treatment.
• The cyst size and appearance should be examined through pelvic ultrasounds on a regular basis.
• In many instances, these cysts resolve spontaneously within a few months.

Medications

• Contraceptive Pills: Oral contraceptives Pills: Oral Methods: Tablets: Pills (Birth control pills/Contraceptive pills/ Hormonal pills etc.)
• Prevents the growth of new cysts, and also reduces the likelihood of ovulation.
• Does not shrink existing cysts.
• Pain Relievers: Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) for instance ibuprofen to control symptoms.

Ovarian Surgery

Surgery is required in the following circumstances:

• Large
• Persistent or growing
• Painful or causing symptoms
• Suspected to be cancerous
• It has close relationship with some complications that include; Rupture and torsion.

Surgical Options:

Laparoscopy (Minimally Invasive):

• Preferred for small, benign-appearing cysts.
• Shorter recovery time.

Laparotomy (Open Surgery):

• Hormonal cysts are used for bigger or potentially malignant cysts. As well as a part of the diagnosis for polycystic ovary syndrome.
• Involves a larger abdominal incision.

Types of Procedures:

• Cystectomy: Surgical treatment – cystectomy that is removal of the cyst only with preservation of the ovary.
• Oophorectomy: Surgery if the cysts are cancerous may require the removal of one or both ovaries (this is, however, rare with benign cysts).

Ovarian Tumor Diagnosis

Diagnosis of ovarian tumor requires physical examination, serial imaging, blood tests, and in some cases – surgical biopsy to determine if the tumor they have is malignant or benign. Below is how ovarian tumors are diagnosed:

Medical History & Physical Exam

• Pelvic exam: To confirm the cysts, a doctor examines for any external lumps or enlargement around the location of the ovaries.
• Symptoms assessed: growing, abdominal pain, irregular menstruation, etc.

Imaging Tests

These assist in determining the size, shape, and position of a tumor:

Pelvic Ultrasound (Transvaginal or Abdominal)

• First-line imaging
• Helps establish whether the mass is solid, a liquid or a combination of both.

CT Scan or MRI:

• Applied to extend examination of suspicious or >PARAFFIN margins or borders of the mass
• By screening if the spread were to be suspected

Blood Tests

This is done with a view of checking some tumor markers:

CA-125:

• Found at high level in many ovarian carcinoma patients and can also be increased in noncarcinomatous conditions such as endometriosis or fibroids.
• Less reliable in premenopausal women

HE4, AFP, hCG, LDH, CEA:

• The following other signs are used in an effort to designate the type of a tumor, particularly in young women, by categorizing the tumor either as a germ cell tumor or as one of the many rare types.

Aspiration or Biopsy (Rarely Done Initially)

• Sometimes not used in suspected cancer to stop the spread of cells
• A biopsy can be done during surgery or Image guided if the tumor is not removable through surgery.

Diagnostic Surgery (If Needed)

And when either imaging or blood tests cannot provide definite clues about the type of the mass, the following steps might be taken:

Laparoscopy (minimally invasive) or Laparotomy

• In definitive diagnosis, the tumor is excised and taken for histological analysis.

Cancer Test (If Cancer Suspected)

• BRCA1, BRCA2, and other mutations are only taken if there is malignancy on the patient.
• Updates treatment and estimates the risk of hereditary disease

Ovarian Cancer Treatment

Ovarian cancer is treated based on the stage of the disease, the type, grade and the general health of the client, and fertility options. Here is the list of usual treatment strategies:

Surgery (Primary Treatment)

Purpose:

• To biopsy and/or surgically excise the tumor to see how far it has progressed (staging).

Types of Surgery:

• Total hysterectomy (removal of uterus)
• Bilateral salpingo-oophorectomy: this is the complete removal of the ovaries and fallopian tubes
• Omentectomy which is the removal of a flap-like layer of fat over the intestines
• Lymph node dissection and excision of samples of the tumor and surrounding tissue.
• Speaking of the initial cancer stage (I), the options for surgical treatment include removal of only one ovary and the uterus.

Chemotherapy

Purpose:

• In an effort to kill any remaining cancer cells after surgery, this research aims at carrying out the following objectives
• Shrink tumors before surgery (neoadjuvant)
• Treat recurrence

Common Regimen:

• Carboplatin + Paclitaxel (first-line combo)
• Given mostly on a three-week cycle of treatment for six cycles.
• Administered through IV
• Common side effects could include nausea, fatigue, temporary hair loss, Peripheral neuropathy that may cause gradual loss of nerve function, and low levels of blood cells.

Targeted Therapy

• Specific for semisituated or repeated ovarian cancers. 

Options:

PARP inhibitors (e.g., olaparib, niraparib):

• For women with BRCA1/2 mutations, and/or Her2 negative and hormone receptor positive tumours or high recurrence score (HRD-positive tumors).

Bevacizumab (Avastin):

• Inhibits tumor blood vessel growth
• May be given adjunct with chemotherapy or as a maintenance drug.

Radiation Therapy

• This intervention is considered quite a rare approach and is used most commonly as the last resort.
• Is sometimes employed to manage specific metastasis or pain.

Clinical Trials

• May give the opportunity to try new effective treatment, such as immunotherapy or vaccine therapy.

Ovarian Cyst Removal

Ovarian cyst removal is performed when the cyst incidences, size, nature, and pain warrant surgery, or if the cyst is malignant. Fortunately, this process is usually done laparoscopically and it is referred to as cystectomy where the cyst is removed but the ovary remains intact or oophorectomy if the ovary also needs to be removed.

Types of Surgery to Remove Ovarian Cyst

Laparoscopy (Keyhole Surgery)

• Most suitable for: Small, harmless-appearing cysts

Technique:

• 2–4 tiny cuts
• Camera and tools inserted to extract the cyst

Advantages:

• Less pain
• Quicker recovery (1–2 weeks)
• Less scarring

Laparotomy (Open Surgery)

• Most suitable for: Extremely large cysts, suspicion of malignancy, or complications
• Technique: Single bigger abdominal cut
• Recovery: 4–6 weeks
• Resorted to if there is suspicion of malignancy or confirmed malignancy

Ovarian Cyst Surgery

Ovarian cyst surgery is done to take out cysts on the ovaries causing symptoms, growing, or being cancerous. The following is a full summary:

Types of Ovarian Cyst Surgery

Ovarian Cystectomy

• What it does: Taking out the cyst alone while leaving the ovary intact.
• Best for: Young women who want to preserve fertility or when the cyst is benign.

Oophorectomy

• What it does: Taking out one or both ovaries.

Employed when:

• The cyst has destroyed the ovary.
• Cancer is suspected.
• Postmenopausal women with a high risk of malignancy.

Ovarian Cyst Causes

Ovarian cysts are fluid-filled sacs that grow on or within the ovaries. They are usually benign (non-cancerous) and are a normal occurrence in the menstrual cycle, but others could be associated with an underlying condition.

• Polycystic Ovary Syndrome (PCOS)
• Endometriosis
• Dermoid Cysts (Teratomas)
• Cystadenomas
• Pregnancy
• Pelvic Infections

Ovarian Cyst Pain Relief

Ovarian cyst pain may be from mild to severe, sharp, and stabbing pelvic pain. Although some cysts disappear by themselves, relief from pain is usually necessary. These are effective methods to alleviate ovarian cyst pain:

• Over-the-Counter Painkillers
• Hormonal Birth Control
• Warm Compress / Heating Pad
• Warm Baths
• Hydration & Herbal Teas
• Gentle Exercise & Yoga
• Diet Adjustments

Ovarian Cyst vs Tumor

Ovarian Cyst

• Ovarian cysts are a fluid-filled pouch that forms on or within an ovary. 
• They are normally benign (not cancerous) and most typically occur as part of the regular menstrual cycle in women of reproductive age. 
• Functional cysts, including follicular cysts and corpus luteum cysts, are the most common ones and usually pass on their own without needing medical treatment. 
• Other cysts such as endometriomas due to endometriosis or dermoid cysts (comprising different tissue types) might remain and have to be followed or excised.

Ovarian Tumors

• Ovarian tumors, in contrast, are abnormal growths that are either solid, fluid-filled, or both. 
• They do not arise from normal ovulatory processes like functional cysts. 
• Tumors can occur from various types of ovarian cells—epithelial, stromal, or germ cells—and can be benign, borderline (low malignant potential), or malignant (cancerous). 
• Tumors usually do not resolve spontaneously and frequently require medical or surgical intervention.

Ovarian Cyst during Pregnancy

Ovarian cysts during pregnancy are fairly common and can usually go without any complications. Nevertheless, their existence can be worrisome, particularly if the cyst gets large or results in symptoms. Below is a summary of the nature of ovarian cysts during pregnancy and how they are treated:

Types of Ovarian Cysts During Pregnancy:

Corpus Luteum Cyst: 

• Most common in early pregnancy. The corpus luteum is a temporary structure that appears on the ovary after ovulation and secretes hormones to maintain pregnancy. Occasionally, it may become filled with fluid, creating a cyst.
• Generally benign and will often resolve by the first trimester.
• If persistent, it will generally not cause issues, although it might be followed.

Functional Cysts: 

These cysts are a part of the menstrual cycle. They usually resolve spontaneously during pregnancy and are not usually a problem unless they become symptomatic or enlarge.

Dermoid Cysts & Endometriomas: 

Uncommon, but these cysts can persist during pregnancy. They tend to need more monitoring because of their size and possible complications.

Ovarian Cyst Complications

Ovarian cysts are usually not malignant and rarely produce any complication, but at times, they can cause complications, particularly when they become enlarged or twisted, ruptured, or infected. The following is an overview of potential complications due to ovarian cysts:

• Ovarian Torsion
• Cyst Rupture
• Infection (Tubo-Ovarian Abscess)
• Impact on Fertility
• Ovarian Cancer (Rare)
• Bleeding
• Pressure on Surrounding Organs

Ovarian Cyst Prevention

Stopping ovarian cysts outright isn't always a guarantee since they usually grow as part of the normal menstrual cycle. However, there are lifestyle behaviours and medical methods which may decrease chances of getting the cysts or help control what causes them. Here are a few of those techniques:

• Hormonal Birth Control
• Manage Polycystic Ovary Syndrome (PCOS)
• Regular Monitoring
• Balanced Diet
• Maintain a Healthy Weight
• Avoid Smoking
• Manage Stress
• Early Treatment of Endometriosis
• Fertility Treatments Monitoring
• Hydration and Detoxification