clinical features

Last reviewed 01/2018

Early in their course, ovarian tumours are often asymptomatic (e.g. on doing a bimanual examination for a smear test) or present with non-specific symptoms. It may be difficult to distinguish benign and malignant tumours.

The most common symptoms of ovarian tumours include:

• pain - most commonly from a rapidly enlarging malignant lesion or one associated with endometriosis. It is unusual in uncomplicated benign lesions

• abdominal girth - may increase significantly due to tumour or ascites. Benign lesions usually enlarge slowly and may not be perceived until the later stages of growth. A large abdominal mass in a cachectic patient with general weight loss may be a striking sign of a malignant lesion. An enlarged abdomen may cause early satiety

• pressure effects - a large tumour in the rectovaginal pouch may displace other pelvic structures upwards so distorting the urethra and producing urinary retention. A tumour pressing down on the bladder may cause urinary frequency. Rarely, an ovarian tumour may cause obstructed labour

• rupture - peritonitis may occur secondary to rupture of a large cyst; a rupture of a malignant cyst may result in spread of malignant cells throughout the abdomen (Pseudomyxoma peritonei)

• endocrine effects - these are relatively uncommon. Endometriomatas and lutein cysts may cause menstrual irregularity. Gonadal stromal tumours may be oestrogenic, androgenic or virilising

• other possible presentations include infarction/haemorrhage of a cyst, torsion of a cyst (see linked items)