
Ovarian cysts and solid ovarian tumors can occur in both children and adults, with cysts being the most common type of ovarian mass. Ovarian cysts are not always cancerous and are usually a normal part of ovulation. However, ovarian neoplasms, which are abnormal masses of tissue forming on the ovary, can be cancerous. The size, type, and location of an ovarian mass determine whether a patient experiences symptoms. Large ovarian masses can cause pain and an increased risk of infection due to ovarian torsion, where the ovary becomes twisted. Treatment options for ovarian masses depend on the diagnosis and the patient's symptoms.
| Characteristics | Values |
|---|---|
| Ovarian cysts | Fluid-filled structures that can develop in the fallopian tubes and ovaries |
| Cause | Hormonal stimulation or bleeding at the time of ovulation |
| Ovarian masses | Endometriomas are associated with endometriosis |
| Ovarian neoplasms | Abnormal mass of tissue forming on the ovary with cells growing and dividing more quickly than they should |
| Tumor size | Tumor size may influence treatment options |
| Treatment | Surgical removal of the tumor and sometimes the surrounding tissue or the affected ovary |
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What You'll Learn
- Ovarian cysts: fluid-filled sacs that can form due to hormonal stimulation or ovulation
- Benign vs malignant: most ovarian tumours are benign, but some can develop into cancer
- Diagnosis: pelvic imaging or ultrasound is used to confirm the presence of an abnormal ovary
- Treatment: surgical removal of the tumour, or the entire ovary in some cases, is often required
- Symptoms: ovarian masses are usually asymptomatic, but can cause pelvic/abdominal discomfort if large

Ovarian cysts: fluid-filled sacs that can form due to hormonal stimulation or ovulation
Ovarian cysts are fluid-filled sacs that form on or within one or both ovaries. They are usually harmless and noncancerous (benign), and often go away without treatment. Ovarian cysts are commonly associated with hormonal stimulation and/or ovulation.
Functional cysts are the most common type of ovarian cyst and are not related to any underlying disease. They are a sign that the ovaries are functioning as they should. Follicular cysts, for example, occur when a small sac in the ovary, called a follicle, does not release an egg during ovulation. Instead, the follicle fills with fluid and forms a cyst. Corpus luteum cysts are another type of functional cyst that forms when the follicle, after releasing an egg, fills with blood or fluid instead of breaking down.
There are other types of ovarian cysts as well. For instance, theca lutein cysts occur after infertility treatment with hormones. The hormones stimulate the growth of egg cells, and cysts may develop as a side effect. Chocolate cysts (endometriomas) are another type of cyst filled with dark, thick blood. They can develop as a result of endometriosis, an inflammatory condition where the uterine lining is found outside the uterine cavity.
Ovarian cysts usually do not cause significant symptoms and are often detected during routine pelvic exams or ultrasounds. However, in rare cases, they can grow large enough to cause severe symptoms and complications. For example, ovarian cysts can rupture, causing pain, dizziness, or weakness. Larger cysts can also lead to a condition called ovarian torsion, where the ovary twists around the tissue supporting it, which can be caused by jerky movements. In such cases, surgery may be required to remove the cyst or, in rare cases, the entire ovary.
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Benign vs malignant: most ovarian tumours are benign, but some can develop into cancer
Ovaries can become enlarged due to cysts, masses, or neoplasms. A neoplasm is an abnormal mass of tissue forming on the ovary with cells growing and dividing more quickly than they should. Ovarian cysts are usually associated with hormonal stimulation and/or ovulation. Most ovarian cysts are functional cysts that occur as a normal part of ovulation and go away within a few months without treatment. However, ovarian cysts can be more concerning in women who aren't ovulating, such as postmenopausal women or girls who haven't started menstruating.
Ovarian tumours are abnormal growths that can be benign or malignant. Benign tumours are slow-growing solid masses that rarely cause symptoms and are usually detected during routine pelvic exams or Pap tests. They are typically treated with surgery, although smaller tumours may be monitored without treatment. Benign ovarian tumours most commonly occur in women of childbearing age. The majority of benign tumours are fibromas, which are benign stromal tumours composed of spindled to ovoid fibroblastic cells producing collagen. Other types of benign stromal tumours include thecomas, while benign epithelial tumours include serous cystadenomas, mucinous cystadenomas, and Brenner tumours.
Malignant ovarian tumours can spread (metastasize) to other parts of the body and can be fatal. About 85-90% of malignant ovarian cancers are epithelial ovarian carcinomas, with the serous type being the most common. Other types of malignant epithelial ovarian carcinomas include mucinous, endometrioid, and clear cell. Malignant stromal tumours include granulosa cell tumours, granulosa-theca tumours, and Sertoli-Leydig cell tumours, which are usually considered low-grade cancers.
While most ovarian tumours are benign, some types may develop into cancer if left untreated. Treatment of ovarian tumours depends on the diagnosis and patient symptoms. If there is a concern for malignancy based on pelvic imaging and tumour markers, the entire ovary may be removed. However, if the risk of malignancy is low, ovarian-sparing surgery may be performed to remove the tumour while leaving the ovary intact.
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Diagnosis: pelvic imaging or ultrasound is used to confirm the presence of an abnormal ovary
Pelvic imaging or ultrasound is used to confirm the presence of an abnormal ovary. Ultrasound imaging of the pelvis uses sound waves to produce pictures of the structures and organs in the lower abdomen and pelvis. It is a non-invasive procedure that does not use ionising radiation. It is safe and painless.
There are three types of pelvic ultrasound: abdominal, vaginal (for women), and rectal (for men). A transvaginal ultrasound is usually performed to view the endometrium (the lining of the uterus), the myometrium (muscular walls of the uterus), the fallopian tubes, and the ovaries. A transrectal ultrasound, on the other hand, involves inserting a lubricated protective cover over the transducer into the rectum.
Ultrasound exams can help diagnose symptoms experienced by women, such as pelvic pain. Transabdominal pelvic ultrasound can detect most larger abnormalities, such as large fibroids, ovarian cysts, neoplasms, etc. However, its view may be limited by abdominal structures such as bowel gas. Thus, transvaginal ultrasound is often used to complement transabdominal ultrasound.
During a pelvic ultrasound, a gel-like substance is applied to the abdomen, and a transducer is pressed against the skin and moved around over the area being studied. The transducer sends out ultrasound waves at a frequency too high to be heard. The sound waves then bounce off the organs and return to the transducer, which processes the reflected waves. These waves are then converted by a computer into an image of the organs or tissues being examined.
Doppler ultrasound is a special ultrasound technique that evaluates the movement of materials in the body, such as blood flow through arteries and veins. It can be used to diagnose ovarian masses with greater confidence, differentiating between benign and malignant masses.
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Treatment: surgical removal of the tumour, or the entire ovary in some cases, is often required
Ovarian cysts, masses, or neoplasms can cause the ovaries to become enlarged. Ovarian cysts are usually benign and asymptomatic, resolving without intervention. However, ovarian masses may require treatment, especially if they cause pain or are suspected to be malignant.
The treatment approach depends on the diagnosis, symptoms, and patient health. Surgical removal of the tumour or the entire ovary may be necessary in some cases. This procedure is called a salpingo-oophorectomy when removing one ovary and fallopian tube, and a bilateral salpingo-oophorectomy when removing both. Surgeons aim to preserve fertility whenever possible, especially in patients of childbearing age.
For larger ovarian tumours, a laparotomy may be performed, and if the tumour is malignant, surgeons may selectively remove part or all of it. In some cases, the entire ovary and fallopian tube are removed, but rarely, both ovaries are taken out. Even if one ovary is removed, the remaining ovary should continue to function normally, preserving hormone effects and reproductive capacity.
Ovarian cancer surgery, also known as debulking surgery, aims to remove as much cancer as possible. This may involve removing other organs, such as the spleen, gallbladder, colon, or parts of the stomach, liver, or pancreas, if they are affected by cancer. The surgeon may also perform an omentectomy, removing the omentum, a fatty tissue layer covering the abdominal contents, as ovarian cancer can spread to this area.
Staging is crucial in ovarian cancer treatment. It involves determining how far the cancer has spread and guiding treatment decisions. Surgeons use imaging tests, intraoperative imaging, and a bright light to locate the tumours during surgery. They may also perform abdominal or peritoneal washing, collecting fluid from the abdominal cavity to test for cancer cells.
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Symptoms: ovarian masses are usually asymptomatic, but can cause pelvic/abdominal discomfort if large
Ovarian masses, including cysts, neoplasms, and tumors, are usually asymptomatic, meaning most women do not experience noticeable symptoms. Ovarian cysts, which are common and typically harmless, often go away without treatment. However, in rare cases, cysts can cause complications that require medical attention.
Ovarian neoplasms, on the other hand, are abnormal masses of tissue that form on the ovary, with cells growing and dividing more rapidly than usual. While they may not cause symptoms initially, they will continue to grow and eventually require surgical intervention.
Ovarian tumors, which are typically benign, are slow-growing solid masses that can develop in or on a woman's ovary. Like cysts, tumors usually do not cause symptoms and are often detected during routine pelvic exams or Pap tests. However, when tumors grow large enough, they can cause pelvic or abdominal discomfort by pressing on nearby organs.
The size, type, and location of an ovarian mass play a role in determining whether symptoms are experienced. Larger masses may be felt or seen as a lower abdominal bulge, particularly in younger patients. Other potential symptoms associated with larger ovarian masses include nausea and vomiting. Pelvic imaging, such as a pelvic ultrasound or MRI, is necessary to confirm the presence and nature of an ovarian mass or tumor.
It is important for women to undergo routine pelvic exams to help ensure that any changes in the ovaries are detected early. While some benign tumors may not require treatment, others may necessitate surgical removal, especially if they cause pain or persist without resolution.
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Frequently asked questions
Ovarian masses are growth formations on the ovaries. They can be solid tumors or fluid-filled cysts.
Ovarian cysts are usually associated with hormonal stimulation and/or ovulation. Ovarian masses like endometriomas are associated with endometriosis. The cause of both benign and malignant neoplasms is uncertain.
Treatment depends on the diagnosis and the patient's symptoms. Most ovarian cysts resolve spontaneously and do not require surgical intervention. Endometriomas and neoplasms often require surgical removal.
Ovarian masses are usually detected during routine pelvic exams or Pap tests. Pelvic imaging, such as a pelvic ultrasound or MRI, may be used to confirm the diagnosis of an abnormal ovary.

























