WOMEN: OTHER BENIGN OVARIAN ENLARGEMENTS. OVARIAN CANCER

Other benign ovarian enlargements

Whether they are cystic or solid or a combination of both, other benign ovarian tumours generally continue to grow and will eventually cause problems. The most common are dermoid cysts and cystadenomas.

Dermoid cysts are extraordinary. They are thought to arise from an ovum that has, for some unknown reason, been stimulated to progress towards foetal development but in a totally disorganized way. Dermoids are most common in women under the age of 30, and are found on both ovaries in around a quarter of cases.

Dermoids are a mixture of solid tissue and cysts, and can contain any body tissue including lung, nervous tissue, skin, hair, teeth, bone and cartilage. The sebaceous and sweat glands in the skin produce an oily fluid that fills cysts and is severely irritating and damaging to the lining of the pelvic and abdominal cavities if a dermoid cyst ruptures.

Cystadenomas are benign overgrowths of cells that secrete watery or mucous fluids. Fluid often collects to form multiple cysts within an outer capsule. The mucous type contains a gelatinous fluid and can grow to enormous size: some have weighed over 20 kg. These cysts can usually be distinguished from follicular and corpus luteum cysts by ultrasound.

Dermoids and cystadenomas won’t disappear spontaneously and can be complicated: they may twist or rupture. Also, they can occasionally become malignant so removal is always advised.

Blood-filled cysts (chocolate cysts) can form on the ovaries affected by endometriosis.

Ovarian cancer

Though ovarian cancer is much less common than cervical or endometrial cancer, it causes more deaths than any other malignancy of the reproductive tract. It is the fourth most common cause of cancer death in Australian women, after that of breast, lung and large bowel.

Ovarian cancer is more common in women over the age of 40, and especially after the menopause. It is particularly malignant because it develops rapidly and spreads early and widely, often before it has caused any symptoms and when the ovaries aren’t noticeably enlarged. There is no screening test for ovarian cancer, and no particular group of women who should be watched carefully for it.

Early diagnosis before spread is uncommon; it is usually a chance discovery further investigation of a slightly enlarged ovary found at routine examination. Sadly, the symptoms of ovarian cancer are usually from the effects of its spread within the abdominal and pelvic cavities. These include indigestion, abdominal discomfort, swelling of the abdomen due to accumulation of fluid, weight loss and loss of energy.

Treatment is by surgery to remove ovaries, uterus and tubes, and all visible signs of spread. Unless it is certain that the tumour hasn’t spread beyond the ovaries, postoperative anticancer drugs (chemotherapy) and radiation therapy are used. Chemotherapy is often used when it appears that all tumour has been removed, in the hope of subduing growth of any microscopic spots.

The outlook depends on the type of cancer and the degree of spread. Your women generally survive longer.

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