Ovarian Tumors: Risks, Diagnosis, and Treatment Options

Ovarian tumor issues?

On April 13, I had a transvaginal ultrasound due to lower abdominal pain, which revealed a 4-5 cm mass.
The doctor indicated that its soft texture suggested it was due to bleeding, and tumor markers were normal.
During a follow-up visit on May 8, another transvaginal ultrasound showed that the mass had not decreased in size (still 4-5 cm), but this time a septation was noted, which raised concerns.
The doctor assessed that this might be an ovarian tumor, indicating that it lies between benign and malignant, and a biopsy is necessary for confirmation.
I have been referred to a gynecologic oncologist.
1.
I would like to understand: If the tumor markers are normal but there is septation, what is the likelihood of malignancy?
2.
Will a CT scan be performed, or will a surgical procedure for biopsy be done directly to determine if it is benign or malignant?
3.
If it is early-stage malignancy, is it possible to preserve the ovary during surgery? I have not yet had children, so I would appreciate your insights.
Thank you.

ting, 30~39 year old female. Ask Date: 2018/05/09

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On April 13, I underwent a transvaginal ultrasound due to lower abdominal pain, which revealed a 4-5 cm mass.
The doctor indicated that its soft texture suggested it was due to bleeding, and tumor markers were normal.
During a follow-up appointment on May 8, another transvaginal ultrasound showed that the mass had not decreased in size (still 4-5 cm), but this time a septation was noted, which raised concerns.
The doctor assessed that this could be an ovarian tumor, indicating that it lies between benign and malignant, and a biopsy would be necessary for confirmation.
I have been referred to a gynecologic oncologist.
1.
I would like to understand: If the tumor markers are normal and there is a septation, does that significantly increase the likelihood of malignancy?
Answer: The risk of malignancy is calculated based on tumor markers such as CA-125, as well as ultrasound findings including tumor size, morphology, wall thickness, and presence of septations.
2.
Will a CT scan be performed, or will a biopsy be done directly to determine if it is benign or malignant?
Answer: Blood tests for CA 19-9, CA 15-3, CEA, AFP, and β-hCG will be conducted, and a CT scan will also be performed.
A biopsy will not be done directly.
3.
If it is early-stage malignancy, can the ovary be preserved during surgery, considering I have not yet given birth?
Answer: If it is early-stage malignancy, the normal contralateral ovary will be preserved, especially since you have not yet had children.

Reply Date: 2018/05/09

More Info

Understanding ovarian tumors is crucial for determining the appropriate course of action when faced with potential abnormalities. In your case, the presence of a 4-5 cm mass in the ovary, along with the discovery of septations (or divisions within the tumor), raises important questions regarding the nature of the tumor—whether it is benign or malignant.

1. Malignancy Risk with Normal Tumor Markers and Septations: The presence of septations in an ovarian mass can be concerning, as it may indicate a higher risk of malignancy. However, normal tumor markers, such as CA-125, can provide some reassurance. CA-125 is a protein that is often elevated in ovarian cancer, but it can also be elevated in benign conditions. The combination of imaging findings (like the presence of septations) and tumor markers is used to assess the risk of malignancy. It is essential to consider other factors, such as your age, medical history, and any symptoms you may be experiencing. Generally, a mass with septations and normal tumor markers may still warrant further investigation, but it does not definitively indicate cancer.

2. Further Imaging and Biopsy: In terms of diagnostic imaging, a CT scan may be recommended to provide a more detailed view of the mass and surrounding structures. This can help in assessing the characteristics of the tumor and any potential spread. However, a biopsy is often necessary to definitively determine whether the tumor is benign or malignant. In many cases, if the mass is suspected to be malignant based on imaging and clinical findings, a surgical approach may be taken to remove the tumor and perform a histopathological examination. This is often done through laparoscopic surgery, which is minimally invasive.

3. Surgical Considerations and Fertility Preservation: If the tumor is found to be malignant, the surgical approach will depend on various factors, including the stage of the cancer and your desire for future fertility. In early-stage ovarian cancer, it may be possible to perform a unilateral salpingo-oophorectomy (removal of one ovary and fallopian tube) while preserving the other ovary, thus allowing for the possibility of future pregnancies. The decision will be made in consultation with a gynecologic oncologist, who specializes in cancers of the female reproductive system.

In summary, the management of ovarian tumors involves a careful evaluation of imaging studies, tumor markers, and clinical findings. If you have a mass with septations, it is essential to follow up with your healthcare provider for further evaluation, which may include imaging studies and possibly surgery. Early intervention can be crucial in managing any potential malignancy while considering your reproductive goals. Always feel free to ask your healthcare provider any questions or express concerns you may have regarding your diagnosis and treatment options.

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