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.
THANK YOU