Management Benign Ovarian Tumours

MANAGEMENT OF BENIGN OVARIAN TUMOURS BY DR. ERIC OBI-THOMAS Dept. Of Obst. & Gynae. UPTH, Port Harcourt.

History Physical examination Diagnosis Investigation Treatment Prognosis Conclusion Recommendation

HISTORY Asymptomatic Gastrointestinal and urinary symptoms – Change of bowel habit Dysphagia Indigestion Constipation Nausea and vomiting

– Abdominal Swelling, pain – Urinary frequency – Dysuria

Abnormality in menstruation Postmenopausal bleeding Family history of Ca ovary and breast

PHYSICAL EXAMINATION General Systematic – Pleural effusion – Ascitis and solid masses – Bimanual examination

INVESTIGALTIONS FBC Urine m/c/s E/u/cr Group and X match blood CXR Abdominal X – R USS IVU CA 125 Estrogen Androgen B - HCG AFP CT MRI Histology

TREATMENT Conservative Surgical Conservative: Premenopausal women Follicular cyst ≤ 3cm in diameter require no further investigations Echo-free, unilocular cyst 3 – 8 cm in diameter, re-examine in 3 – 6 months Postmenopausal women 3 – 6 monthly USS. Monitor CA 125.

Surgical Treatment Symptomatic patients Most postmenopausal women Premenopausal women with large cysts. Symptomatic patient

– Emergency laparoscopy or laparotomy in patients with severe, acute pain or signs of intraperitoneal bleeding.

Postmenopausal women

– Mass > 10cm, unilateral and fit for surgery; better for staging procedure, peritoneal washing for cytology, exploration of the abdomen, removal of infracolic omentum, TAH and BSO

Premenopausal women – Individualize – Hysteroscopy – Endometrial curettage – Cystectomy – Unilateral solpingo-oophorectomy – Biopsy of contra-lateral side

Laparoscopy Reduced stay in hospital Economical Aspiration and fenestration Cystectomy Oophorectomy or Salpingo-oophorectomy

Prognosis - good

CONCLUSION Small asymptomatic benign tumours in young women usually resolve spontaneously. Solid ovarian tumours are often malignant and are usually germ cells or sex-cord stromal tumours in young women. Laparoscopic removal of ovarian cyst should be limited to those with no malignant features.

RECOMMENDATION Women should be adequately sensitized to adopt a screening culture so as to detect ovarian and other masses before such tumours become clinically significant.

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