Ovarian Tumors

About Ovarian Tumors

Ovarian tumor surgery can be performed by conventional open method or by laparoscopy. Laparoscopic or Laproscopic cancer surgery has several advantages over conventional open surgery with same cure rate. Only surgery is curative in most of the cancers. Additional therapies (chemotherapy & radiotherapy) are mostly supportive. But, many patients and their relatives try to avoid surgery for the fear of the immense trauma for their loved ones, resulting in patient getting wrong or less effective treatment. With laparoscopy the trauma is much less and makes the treatment more acceptable. The Team MACS precisely addresses all these issues and works relentlessly for a better life.


MBBS, MRCSEd, DNB (Gen Surg),
MNAMS (Gen Surg), DNB (Surgical Oncology),

Fellowship in Laparoscopic and Robotic Onco-Surgery.
Dr Nayak is one of the leading senior Surgical Oncologists (cancer surgeon) of Bangalore. He is one of the pioneers of Laproscopic (laparoscopic) cancer treatment (surgery). He is the Director of Surgical Oncology at Fortis Hospital, Bangalore.

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About Ovary And Its Tumors

Ovary is the organ where ova or eggs are produced. It is a female reproductive organ. Normal women have a pair of ovaries on either side of uterus which produces single egg every month during reproductive age.

Tumors of ovary include:

Begin tumors of ovary. These can be cystic (fluid filled) or solid tumors. All cysts of ovary are tumors. These appear and disappear throughout life and usually have no implications (functional) and do not need any treatment. Benign tumors of ovary like mucinous or serous cystadenomas or cystic teratomas or fibromas account for 70% of ovarian tumors. These tumors need to be surgically removed if they fail to respond to conservative treatment as some can turn cancerous if left alone.

These ovarian cancer accounts for about 70% of all ovarian cancers. The origin of the tumor could from surface of ovary, fallopian tube or the inner lining of abdomen (pertonium). Microscopically these can be serous, mucinous, clear cell, and endometrioid variety. Serous cell type is the most common variety. All these are treated the same way.

Borderline ovarian tumors: These are tumor that originate in the epithelial layer, but are less aggressive than epithelial ovarian cancer. They less than 10% of epithelial ovarian cancers. They are most often serous or mucinous cell types. They often have presentations of large masses, but uncommonly spead far. Usually surgery is curative in these cases.

Other ovarian tumors: germ cell tumors and sex cord-stromal tumors usually occur at young age. These tumors arise from the inner substance of ovary. These are generally less aggressive cancers. These are detected early due to pain or other symptoms. Surgery can cure most of these cases.

Symptoms And Diagnosis

Ovarian tumors are notoriously asymptomatic. Now a days ovarian tumor are detected on routine ultrasound examination and are investigated further. In some other cases, they may cause early symptoms. The most common symptoms of ovarian cancer include:

These symptoms are very common and do not always represent ovarian cancer. If these symptoms appear almost daily for more than 2 or 3 weeks, they should be investigated.

Ultrasound scan is usually gives the diagnosis. CT scan may be used to see distant spread. Needle biopsy (FNAC) should never be performed on suspected ovarian tumors as this can burst the cancer and convert an early cancer into 4th stage cancer.

Staging & Treatment

Most of the cancers of ovary can only be staged accurately during surgery which serves both as treatment as well as staging procedure (conventional surgery is called staging laparotomy). In case of Team MACS, diagnostic staging laparoscopy is performed as a first step of surgical procedure and this gives better idea about the stage of the disease and possibility of surgery. The most commonly followed staging system for these tumors is proposed by FIGO (International Federation of Gynecology and Obstetrics).

Benign tumors of ovary are best treated laparoscopically (Total Laparoscopic Hysterectomy or Laparoscopic Salpyngo-oophorectomy or Laparoscopic cystectomy.

Cancer of ovary.
Management of cancer of ovary depends on the stage of the disease. This para presents a simplified version of the FIGO staging along with management. All modalities (surgery, chemotherapy and radiotherapy) of treatment are used to manage the disease effectively.

Stage IA

cancer is limited to one ovary and the tumor is confined to the inside of the ovary. There is no cancer on the outer surface of the ovary. There are no ascites (free fluid in the abdomen) present containing malignant cells. The capsule of ovary is intact. The germ cell tumors and sex cord-stromal tumors usually present in this stage.

Treatment: As these occur at young age, preservation of fertility is important. The standard procedure for stage IA today is laparoscopic salpingo-oopharectomy. Cure is possible in most of the cases. Chemotherapy is needed in most of the cases.

Stage IB to II

These stages indicate that the cancer is limited to pelvic organs pelvis (lower part of abdomen). Lowest of the stage (IB) indicates the involvement of both the ovaries. The stage II indicates the involvement of other pelvic organs. There are no peritoneal or lymph nodal deposits (inner lining of abdomen).

Treatment: These stages are best treated with surgical removal of uterus with both the ovaries and tubes. The omentum (large fatty structure which essentially hangs off the middle of your colon and drapes over the intestines inside the abdomen) also is removed. These stages also benefit from removal of lymph nodes along aorta as disease may be spread in upto 30% of patients into these. This can be performed by conventional open method or by laparoscopy. Chemotherapy is needed in these cases.

Stage III

In this stage the cancer has spread beyond the pelvis (lower part of abdomen) into the upper part of abdomen and / or the cancer has spread to lymph nodes. Many of these patients come with large fluid collection in their belly (ascites).

Treatment:When stage III diagnosed before surgery, most of the oncologists advise chemotherapy first followed by surgery in order to make surgery easier by reducing the bulk of the disease. This can be performed by conventional open method or by laparoscopy. However, surgery may be performed in some cases as the first step.

Stage IV

This indicates that distant organs like liver, lung, etc are involved by cancer. This is the most advanced stage of cancer.

Treatment: Usually cure is not possible. However, chemotherapy and surgery remain the main treatment modalities.