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Ovarian Tumor – Causes, Symptoms and Treatment

An ovarian tumor is an abnormal growth on one or both ovaries, which can be benign or malignant. Early diagnosis is key to successful treatment.

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An ovarian tumor is an abnormal growth on one or both ovaries, which can be benign or malignant. Early diagnosis is key to successful treatment.

What Is an Ovarian Tumor?

An ovarian tumor is an abnormal growth of tissue that develops on one or both ovaries. These tumors can be benign (non-cancerous), borderline (low malignant potential), or malignant (cancerous). Ovarian tumors are among the most common gynecological conditions and can affect women of all ages, though they are most frequently diagnosed during the peri- and postmenopausal years.

Causes and Risk Factors

The exact causes of ovarian tumors are not fully understood. Known risk factors include:

Genetic predisposition: Mutations in the BRCA1 and BRCA2 genes significantly increase the risk of malignant ovarian tumors.
Family history: Women with a mother or sister who has had ovarian cancer face a higher risk.
Hormonal factors: Early onset of menstruation, late menopause, or hormone replacement therapy may influence risk.
Nulliparity: Women who have never been pregnant have a slightly higher risk.
Age: Risk increases significantly after the age of 50.
Obesity: Being overweight is associated with an elevated risk.

Types of Ovarian Tumors

Ovarian tumors are classified by their cell of origin into several groups:

Epithelial tumors: The most common type, originating from the surface epithelium of the ovary (e.g., serous, mucinous, or endometrioid tumors).
Germ cell tumors: Arising from the egg-producing cells, these more commonly affect younger women (e.g., teratomas, dysgerminoma).
Sex cord-stromal tumors: Arising from connective tissue of the ovary; some are hormonally active (e.g., granulosa cell tumor).
Borderline tumors: Slow-growing tumors without invasive characteristics, considered an intermediate form between benign and malignant.

Symptoms

Ovarian tumors often cause no or only vague symptoms in early stages. Possible signs include:

Pressure or pain in the lower abdomen
Bloating or a feeling of fullness
Frequent urination
Changes in the menstrual cycle
Unintentional weight loss
Increased abdominal girth (with large tumors or fluid accumulation)
Nausea or digestive problems

Because these symptoms are non-specific, ovarian tumors are often not detected until an advanced stage.

Diagnosis

Several diagnostic methods are used to identify an ovarian tumor:

Gynecological examination: Manual palpation of the ovaries to detect enlargement or abnormalities.
Transvaginal ultrasound: Imaging to assess the size, shape, and structure of the tumor.
Tumor markers: Blood tests for CA-125 (especially for suspected epithelial tumors), AFP, and HCG (for germ cell tumors).
MRI or CT scan: Detailed imaging to assess the extent of the tumor and possible spread.
Histological examination: A definitive diagnosis is made through tissue biopsy or after surgical removal.

Treatment

Treatment depends on the type, size, and stage of the tumor, as well as the age and desire for future pregnancies:

Surgery

Surgery is the primary treatment. Depending on findings, the tumor alone, the affected ovary (oophorectomy), or in the case of malignancy the uterus and lymph nodes as well (hysterectomy with salpingo-oophorectomy) may be removed. For younger women who wish to preserve fertility, a fertility-sparing approach is pursued when possible.

Chemotherapy

Malignant ovarian tumors are often treated with chemotherapy, most commonly with a combination of carboplatin and paclitaxel. This can be given after surgery (adjuvant) or before surgery (neoadjuvant).

Targeted Therapy

For patients with specific mutations (e.g., BRCA1/2), PARP inhibitors such as olaparib are used to interfere with DNA repair mechanisms in tumor cells.

Radiation Therapy

Radiation therapy plays a limited role in treating ovarian tumors but may be used as a complementary approach in selected cases.

Prognosis

Prognosis strongly depends on the stage at diagnosis. In early-stage disease (FIGO I), the 5-year survival rate exceeds 90%. In advanced stages (FIGO III/IV), this rate decreases significantly. Regular gynecological check-ups are therefore recommended to detect tumors as early as possible.

References

Leitlinienprogramm Onkologie: S3-Leitlinie Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren, Version 5.1 (2023). AWMF registration number: 032-035OL.
Prat J. et al. - FIGO's staging classification for cancer of the ovary, fallopian tube, and peritoneum. International Journal of Gynaecology and Obstetrics, 2014.
World Health Organization (WHO) - Classification of Tumours of Female Reproductive Organs, 5th Edition (2020).

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