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Ovarian masses and ovarian cancer
An ovarian mass is assessed by the woman's age, the ultrasound appearance and blood markers: a simple cyst in a young woman is almost always benign, while a complex mass with solid parts, flow, ascites or a raised CA-125 in a postmenopausal woman needs referral to a gynaecological oncologist.
Why it matters in the exam
Exam questions swing between two extremes. On one side, a young woman with a simple or haemorrhagic cyst — and the answer is surveillance, not surgery. On the other, an older woman with abdominal bloating, early satiety, a complex mass and ascites — and the answer is surgery in an oncology centre. In between come tumour markers: CA-125 is useful mainly after menopause, because before it rises also with endometriosis, fibroids and pelvic infection. A recurring emergency is ovarian torsion: sudden pain with nausea and a mass, and normal Doppler flow does not exclude it.
The second theme is the tumour types: epithelial tumours (most cancers, older women, BRCA), germ cell tumours (young women, with special markers: LDH in dysgerminoma, AFP in yolk sac tumour, hCG in choriocarcinoma), and sex cord-stromal tumours (granulosa cell secretes oestrogen and inhibin, Sertoli-Leydig secretes androgens). Meigs syndrome is a fibroma with ascites and a pleural effusion, and a Krukenberg tumour is a metastasis from the stomach. BRCA carriers need risk-reducing removal of the ovaries and tubes — at 35–40 for BRCA1 and 40–45 for BRCA2 — because there is no effective screening for ovarian cancer.
Key points
- Simple cyst = surveillance; complex mass in an older woman = oncology referral.
- CA-125 is useful mainly after menopause.
- Germ cell tumours: LDH, AFP, hCG; in young women.
- Torsion: sudden pain and a mass; laparoscopy even with normal Doppler.
- BRCA1: risk-reducing surgery at 35–40; BRCA2: at 40–45.
Summary table
| Type | Age and picture | Marker or sign | Treatment |
|---|---|---|---|
| Functional or simple cyst | Reproductive age; thin wall, no solid parts | None | Ultrasound surveillance; most cysts resolve |
| Mature teratoma (dermoid) | Young women; fat and calcification | Risk of torsion | Cystectomy preserving the ovary |
| Malignant epithelial tumour | Postmenopausal; complex mass, ascites, vague symptoms | Raised CA-125; BRCA or Lynch | Maximal cytoreductive surgery and chemotherapy (carboplatin and paclitaxel); PARP inhibitors in BRCA carriers |
| Germ cell tumours | Girls and young women; fast-growing solid mass | LDH (dysgerminoma), AFP (yolk sac), hCG (choriocarcinoma) | Fertility-sparing surgery and chemotherapy; high cure rate |
| Sex cord-stromal tumours | Any age | Granulosa: oestrogen and inhibin, endometrial hyperplasia; Sertoli-Leydig: virilisation | Surgery; in granulosa — assess the endometrium |
| Ovarian torsion | Sudden pain, nausea, mass above 5 cm | Doppler flow does not exclude it | Urgent laparoscopy, detorsion and ovarian preservation |
Free exam questions
מהי ההפרע ה העומדת בבסיס תסמונת McCune Albright ? (the question as examined, in Hebrew)
- א. פעילות אוטונומית של Gq –Coupled Receptor
- ב. פעילות אוטונומית של Adenylate Cyclase
- ג. שיפעול אוטונומי של מערכת Calcium-Calmodulin
- ד. יז רחון של החומצה האמינית Serine במקום Tyrosine ברצפטור לאינסולין
12-year-old female, usually healthy, has not yet menstruated. Presents at the ER with lower right abdominal pain - sudden onset with great intensity. On examination - tender lower right abdomen. Ultrasound - right ovary is enlarged and in a different position compared to the left one, an edematous appearance and a whirlpool sign is demonstrated. What is the recommended treatment for this case?
- A. Broad-spectrum antibiotics
- B. Opiate painkillers
- C. Combined hormonal therapy
- D. Laparoscopy
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Sources
- ACOG Practice Bulletin No. 174, 2016 — Evaluation and Management of Adnexal Masses
- ACR O-RADS US Risk Stratification and Management System, 2020 — Adnexal lesions on ultrasound
- NCCN Guidelines: Ovarian Cancer, 2024 — Epithelial ovarian cancer; risk-reducing surgery
- Berek and Novak's Gynecology, 16th edition (2019) — Ovarian Cancer
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.