Womens Health

How to tell if an Ovarian Mass is Malignant

Frederick R. Jelovsek MD

Just as a breast lump is frightening because it may mean cancer, so is a pelvic mass that the doctor thinks may possibly be ovarian cancer. Most women, if given a choice, would rather have a gynecologic oncologist who has had specialized training do the surgery. This is especially true if they knew that the mass was going to turn out to be malignant and spread beyond the ovary.

Most local hospitals do not have a gynecologic cancer specialist on staff, so the dilemma becomes "what criteria should be used to strongly recommend that a woman have her surgery at a regional center?"

A recent study in Norway looked how to predict whether a woman with possible ovarian malignancy should be referred to the regional cancer center. Tingulstad S et al: The risk-of-malignancy index to evaluate potential ovarian cancers in local hospitals. Obstet gynecol 1999;93:448-52.They looked at 365 women from seven local hospitals that were evaluated with a risk scoring system to see if they should be transferred to the central cancer hospital. This study answers several questions about the ultrasound findings, age, menopausal status and CA 125 serum test measurement (an ovarian cancer antigen) and how they can be used to predict the chance of malignancy.

Can the doctor tell if an ovarian tumor is malignant by vaginal ultrasound?

Malignancy of the ovary cannot be diagnosed with any certainty by ultrasound. The best that can be done is to identify characteristics that make it more likely to be malignant or benign.

There are many benign pelvic conditions that can appear on ultrasound as worrisome for malignancy. These include: benign epithelial and functional ovarian cysts, hemorrhagic ovarian cysts, endometriosis, dermoid cysts (benign teratomas), ovarian fibroids, uterine fibroids, fimbrial cysts, hydrosalpinges (swollen, fluid-filled faloppian tubes), pelvic abscesses, pelvic adhesions, bowel adhesions and adenomyosis.

How common are ovarian malignancies in younger women?

If you look at the distribution of ages in this study (confined to women over 30), you will see that benign tumors and causes of ovarian masses can occur in all age ranges. Malignancy of the ovary definitely is higher in older women and lower in frequency in the younger ages.

Risk of Malignancy Age Distribution

30-44 106 (37%) 11(15%)
45-54 104 (36%) 17(23%)
>=55 80 (28%) 47(63%)
Table of Contents
1. Ovarian Mass
2. Is age a factor?
3. When is surgery best?
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