Ovary can have tumors ranging from benign tumor (not cancer) to borderline to malignant tumors(cancer). It occurs mostly in people more than 50 years, but it can affect any age group. Like breast cancer, 5 to 10% of ovary cancers also run in families.

Risk factors

• Early puberty and late menopasue
• Polycystic ovarian syndrome
• Breast ovarian cancer syndrome

Clinical Features

• Insidious disease with few warning signs and symptoms
• Menstrual abnormalities
• Early fullness of stomach after having food
• Abdomen fullness and distension( often people correlate this to becoming obese)
• Rarely pain

Evaluation

Whenever there is a doubtful mass from ovary, it should be investigated to find whether it is cancer or not. It is very common for benign tumors(not cancer) also to grow to huge size.

Ultrasound or MRI of lower abdomen can help to differentiate a cancer tumor most of the time.

Tumor marker like serum Ca 125 levels. In advanced cases CT scan of abdomen, pelvis and chest or PET CECT scan of whole body. A suspicious ovary mass should never be biopsied, as it can cause rupture of tumor and spillage of cancer cells in abdomen cavity.

Stage of Disease

• Very Early stage – Disease is limited only to ovaries
• Early stage – Disease limited to ovaries and uterus
• Advanced – Disease spread inside abdomen, apart from ovaries
• Very advanced – Spread to organs like liver, lung

Treatment

If a tumor is suspicious for malignancy, a simple surgery like removing the ovarian mass and confirming with immediate pathological examination is needed(frozen section). If tumor is malignant then removal of uterus, other ovary, omentum and other lymph nodes in abdomen is done(cytoreductive surgery).

In advanced stage, chemotherapy is first given to shrink the disease(NACT) and then cytoreductive surgery is done.In early stages of the disease and in young females a fertility sparing surgery can be offered.