Malignant tumours of the ovary

Most ovarian tumours are of epithelial origin. These are rare before the age of 35 years. The incidence increases with age to peak in the 50-70 years old age group.

Aetiology:
• Incessant ovulation theory: epithelial tumours are most frequently associated with nulliparity, an early menarche, a late age at menopause & a high estimated number of years of ovulation. Oral contraceptive use reduces the risk fourfold.
• Subfertility treatment: there might be a link between ovarian cancer & prolonged attempts at induction of ovulation.
• Genetic factors:
Familial ovarian cancer: There is a positive family history in 5-10 % of women with epithelial ovarian cancer. A woman with one effected close relative has a lifetime risk twice that in the general population. A particular feature of familial cancers is the relatively early age at which they occur. Most of these families also have cases of breast or colorectal cancer in the family. The defective gene is most commonly the tumour-suppressor gene BRCA1 (80% of cases), BRCA2 (14% of cases).

Management of women with a family history of ovarian cancer:
Once identified, women with a high risk of ovarian & breast cancer are difficult to advise. Annual ovarian ultrasonography with a color-flow Doppler studies & serum CA 125 estimation every 6-12 months are recommended, but it is uncertain how much protection this offers. Prophylactic bilateral oophorectomy, combined with hysterectomy is recommended for clearly defined high-risk women after completion of their family after 45 years of age.





Classification of malignant ovarian tumours:
1. Epithelial tumours:
• Serous cystadenocarcinoma
• Mucinous cystadenocarcinoma
• Endometrioid cystadenocarcinoma
• Clear cell (mesonephroid ) tumour
• Brenner tumour
• Undifferentiated carcinoma

2. sex cord tumours
• Granulosa cell tumour
• Androblastoma ( Sertoli-Leydig cell tumour)
• Gynandroblastoma
3. Germ cell tumour
• Dysgerminoma
• Endodermal sinus tumour (yolk sac tumour)
• Embryonal cell tumour
• Choriocarcinoma
• Teratoma
• Mixed tumours
4. Metastatic tumours