Ovarian masses

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Chapter 3
Ovarian masses

Chapter 3 – The Ovary

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The Ovary: An introduction
Ovarian masses
Ovarian cysts
Ovarian cancer
Polycystic ovary syndrome
Premature ovarian insufficiency
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References

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Assessment

Ovarian cysts are common, occurring in 6.6 per cent of premenopausal and 5-17 per cent of postmenopausal women. ⁽²⁾⁽⁴⁾

Most ovarian masses in premenopausal women are functional cysts (usually derived from physiological ‘follicles’) and other common causes include endometriomas and benign tumours (usually ‘cystadenomas’). Large ovarian cysts are an established risk factor for ovarian torsion. Other causes of ovarian masses include dermoid cysts, theca lutein cysts (which can result from ovarian stimulation as well as gestational trophoblastic disease), corpus luteal cysts (especially in early pregnancy), tubo-ovarian abscesses (resulting from pelvic infection) and ovarian malignancy (of which there are several distinct types). Up to 10 per cent of women will have some form of surgery during their lifetime for the presence of an ovarian mass. ⁽²⁾

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Drake R, Vogl AW, Mitchell AWM. Gray’s Anatomy for Students E-Book: Elsevier Health Sciences; 2009.

Borgfeldt C, Andolf E. Transvaginal sonographic ovarian findings in a random sample of women 25-40 years old. Ultrasound Obstet Gynecol. 1999;13(5):345-50.

Royal Australian College of General Practitioners (RACGP). Guidelines for preventive activities in general practice. East Melbourne, Victoria; 2016.

Royal College of Obstetricians and Gynaecologists, The British Society for Gynaecological Endoscopy. Management of Suspected Ovarian Masses in Premenopausal Women. RCOG/BSGE Joint Guideline. Report No.:62. [Internet]. 2011 [updated 2011 Nov 1].

The Royal Australian College of General Practitioners (RACGP). Guidelines for preventive activities in general practice. 9th ed. East Melbourne, Victoria: RACGP; 2018.

Royal College of Obstetricians and Gynaecologists. The Management of Ovarian Cysts in Postmenopausal Women. Report No.: 34 [internet]. 2003 [updated 2016 July]. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_34.pdf.

Yeoh M. Investigation and management of an ovarian mass. Aust Fam Physician. 2015;44(1-2):48-52.

Cancer Council Australia. Understanding Ovarian Cancer: A guide for people with cancer, their families and friends. [Internet]. Sydney, NSW: Cancer Council Australia; 2003 [updated 2020 April]. Available from: https://www.cancer.org.au/assets/pdf/understanding-ovarian-cancer-booklet.

Australian Institute of Health and Welfare (AIHW). Cancer data in Australia. Cat no.: CAN 122. [internet]. Australian Government; 2018 [updated 2019 Jul 26]. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/summary.

10.

Lux M, Fasching PA, Beckmann MW. Hereditary breast and ovarian cancer: review and future perspectives. J Mol Med (Berl). 2006;84(1):16-28.

11.

Rustin G, Nelstrop AE, Tuxen MK, Lambert HE. Defining progression of ovarian carcinoma during follow-up according to CA 125: a North Thames Ovary Group Study. Ann Oncol. 1996;7(4):361-4.

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Sagi-Dain L, Lavie O, Auslander R, Sagi S. CA 19-9 in evaluation of adnexal mass: retrospective cohort analysis and review of the literature. Int J Biol Markers. 2015;30(3):e333-40.

13.

Moore R, McKeein DS, Brown AK, DiSilvestro P, Miller MC, Allard WJ, et al. A novel multiple marker bioassay utlizing HE4 and CA 125 for the prediction of ovarian cancer in patients with a pelvic mass. Gynecol Oncol. 2009;112(1):40-6.

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Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol. 1990;97(10):922-9.

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National Institute for Health and Care Excellence (NICE). Ovarian cancer: recognition and initial management. Report No.:CG122. [internet]. United Kingdom: NICE; 2011. Available from: https://www.nice.org.uk/Guidance/CG122.

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Advice about familial aspects of breast cancer and epithelial ovarian cancer: A guide for health providers [internet]. Cancer Australia: Australian Government; 2010 (updated 2015). Available from: https://canceraustralia.gov.au/sites/default/files/publications/advice-about-familial-aspects-breast-cancer-and-epithelial-ovarian-cancer/pdf/2015_bog_familial_aspects_int.pdf.

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Neesham D. Ovarian cancer screening. Aust Fam Physician. 2007;36(3):126-8.

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Australian Government Cancer Australia. Familial Risk Assessment FRA-BOC [Internet]. Available from: https://canceraustralia.gov.au/clinical-best-practice/gynaecological-cancers/familial-risk-assessment-fra-boc.

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Australian Government National Health and Medical Research Council. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Guidelines. Melbourne, Victoria; 2018.

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Illingworth P. How to treat: Infertility. Australian Doctor. 2010;7(May):31-8.

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Deeks A, Gibson-Helm ME, Paul E, Teede HJ. Is having polycystic ovary syndrome a predictor of poor psychological function including anxiety and depression? Hum Reprod. 2011;26(6):1399-407.

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Coffey S, Mason H. The effect of polycystic ovary syndrome on health-related quality of life. Gynecol Endocrinol. 2003;17(5):379-86.

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Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25.

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Lord J, Flight IH, Norman RJ. Metfomin in polycystic ovary syndrome: systematic review and meta-analysis. BMJ. 2003;327(7421):951-3.

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Reproductive and Sexual Health Handbook

Chapter 3 – The Ovary

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Find the information you need

Ovarian masses

Assessment

Presentation

Investigation

Management