Ovarian and Fallopian Tube Tumors

• Ovarian and Fallopian Tube Tumors


  • Many types of benign and malignant tumors
  • 80% of ovarian tumors are benign
  • Ovarian cancer is the second most common cancer of the female genital tract
  • Ovarian cancer is the fifth most common cause of cancer death and the most common cause of gynecologic cancer death
  • Fallopian tube carcinoma is extremely rare, but the incidence is likely underestimated
• Ovarian carcinoma accounts for 25% of all gynecologic malignancies (21,990 new cases per year), but it is responsible for over 50% of deaths from cancer of the female genital tract (15,460 deaths per year)
• The high mortality is due in part to the lack of effective screening tools for early diagnosis and presentation at late stages of disease when tumors have spread throughout the peritoneal cavity and the chance for cure is low
• The overall 5-year survival rate for women with ovarian carcinoma is only 25% to 45%
• A high degree of suspicion and prompt diagnosis and intervention are critical
• Tumors of the ovaries are associated with one of the three distinct components of the ovary


  • Surface epithelium
  • Ovarian germ cells
  • Ovarian stroma
• Over 65% of all ovarian tumors and 90% of all ovarian cancers are epithelial tumors on the ovary capsule
• About 5% to 10% of ovarian cancer is metastatic from other primary tumors in the body, usually from the gastrointestinal tract, known as Krukenberg tumors, or the breast and endometrium
• Ovarian cancer is spread primarily by

  1. Direct exfoliation of malignant cells from the ovaries

  2. Lymphatic spread to the retroperitoneal pelvic and para-aortic lymph nodes

  3. Hematogenous spread to the lung and brain
• In advanced disease, intraperitoneal tumor spread leads to accumulation of ascites in the abdomen and encasement of the bowel with tumor, resulting in intermittent bowel obstruction known as a carcinomatous ileus
• In many cases, this progression results in malnutrition, slow starvation, cachexia, and death
• Ovulation


  Disrupts the epithelium of the ovary and activates the cellular repair mechanism, providing the opportunity for somatic gene deletions and mutations during the cellular repair process
• An emerging theory is that serous ovarian cancers originate in the distal fallopian tube
• Familial cancer syndromes associated with increased risk of ovarian cancer

  • BRCA1 gene mutations
  • BRCA2 gene mutations
  • Lynch II syndrome (hereditary nonpolyposis colorectal cancer syndrome [HNPCC])
• High dietary fat and agents such as talc and asbestos have also been proposed as possible etiologic agents in the pathogenesis of ovarian carcinoma
• Average woman's lifetime risk of developing ovarian carcinoma

  1 in 70
• Average woman's lifetime risk of dying from invasive ovarian cancer


  1 in 95
• Median age of diagnosis of ovarian cancer

  61 years
• Two-thirds of women with ovarian cancer are over the age of 55 at the time of diagnosis
• Hereditary ovarian cancers typically occur in women who are, on average, 10 years younger than those with nonhereditary ovarian cancer, whereas nonepithelial ovarian cancers are more common in girls and young women
• There is a slightly increased frequency in Caucasian women compared to the incidence in Hispanic, Asian, and African American women
• Major risk factors for ovarian cancer

  • Familial ovarian cancer syndrome (BRCA1, BRCA2, or Lynch II syndrome/HNPCC)
  • Family history of ovarian cancer
  • Personal history of breast cancer
  • Early menarche (<12 y)
  • Infertility
  • Nulliparity
  • Delayed childbearing
  • Late-onset menopause (>50 y)
  • Increasing age
  • Use of talcum powder on the perineum
  • Obesity (BMI > 30)
• Protective factors against ovarian cancer

  • Use of oral contraceptives (OCPs) for >5 years
  • Breastfeeding
  • Multiparity
  • Chronic anovulation
  • Tubal ligation
  • Hysterectomy
• Use of OCPs for greater than 5 years can reduce the risk of ovarian cancer by 50%
• Tubal ligation and hysterectomy have been associated with a 67% and 30% reduction in ovarian cancer, respectively, even in patients with a familial cancer syndrome
• Common symptoms of ovarian cancer

  • Bloating
  • Early satiety
  • Dyspepsia
• Patients with ovarian cancer are most often asymptomatic or have vague, nonspecific complaints until the disease has progressed to the advanced stages
• Symptoms that may develop as ovarian cancer progresses

  • Gastrointestinal complaints (nausea, anorexia, indigestion)
  • Urinary frequency
  • Dysuria
  • Pelvic pressure
  • Ascites leading to shortness of breath secondary to pleural effusion
  • Ventral hernia
• There is no evidence to suggest that routine pelvic examination improves the early diagnosis of ovarian cancer
• Findings on physical examination as ovarian cancer progresses

  • Solid, fixed, irregular pelvic mass
  • Ascites
  • Sister Mary Joseph nodule (ovarian cancer metastasis to the umbilicus)
• The likelihood of cancer in a pelvic mass is higher in postmenopausal women (30% to 60%) compared to premenopausal women (5% to 15%)
• Diagnostic tools for investigating an adnexal mass

  • Pelvic ultrasound
  • Computed tomography (CT) of the pelvis and abdomen
  • Magnetic resonance imaging of the pelvis and abdomen
• Malignant cells can spread via direct exfoliation, so paracentesis and cyst aspiration should be avoided
• Additional studies to look for metastatic disease and distinguish between primary and secondary ovarian cancer

  • Barium enema
  • Intravenous pyelography
• Depending on the type of tumor, ovarian malignancies can be monitored using the serum tumor markers CA-125, HCG, AFP, and LDH
• Bleomycin, etoposide, and cisplatin (Platinol) (BEP)


  Most common regimen for germ cell tumors
• Serum tumor markers


  Can be used to judge the effectiveness of therapy between chemotherapy cycles in patients with elevated levels prior to treatment
• Radiation therapy was previously used as the primary treatment for dysgerminomas, which are exquisitely sensitive to radiation
• Current combination chemotherapy regimens have proven to be as good as or better than radiation therapy for dysgerminomas
• Chemotherapy is more protective of future fertility when only one ovary is removed