Ovarian masses: Causes, symptoms and diagnosis

Written by: Mr Ahmad Sayasneh
Edited by: Karolyn Judge

There are various types of ovarian masses and cysts, and here to provide a detailed insight to them and how they are treated is highly-experienced consultant in gynaecology and gynaecological oncology surgery, Mr Ahmad Sayasneh.


Learn more about the different ovarian masses that can occur, how they are treated and the statistics surrounding cases of ovarian cancer, and more, in this informative article.


Older woman with a concerned expression looking out of a window


What causes ovarian masses?

Ovarian masses can happen randomly to many patients. However, there are some ovarian masses in the cancer group, which are related to some genetic malformations. In particular, there is a gene called BRCA1 and BRCA2. There's the MLH1 gene, too. These ones are responsible for about ten per cent of all ovarian cancers


However, benign ovarian masses normally happen randomly and there's no genetic background. Some of them can happen in younger women, and some of them can happen more in older women. The ones which are very well known in younger women are called the teratoma or the dermoid, and they normally happen in younger age groups, or women who are trying to get pregnant. There's the other group of benign tumours called endometriomas and these ones happen in younger women, and they are hormone dependent. 


There's oestrogen; in younger women they are more likely to grow unlike in older women where there are less hormones, so some other masses can occur like serous cystadenoma, which normally don't have hormone receptors and they aren't related to menopausal stages.



What are the symptoms of ovarian masses?

They have a wide range of symptoms. They can cause no symptoms at all and they can cause very non-specific symptoms like irritable bowel symptoms, like waves between diarrhoea and constipation. They can cause tummy pain; they can cause pressure on other organs like the bladder which can cause the bladder to be overactive or have more frequent urination. They can block the urethras and cause hydronephrosis and kidney problems and no urination at all. They can block the bowels sometimes and cause bowel obstruction, and the symptoms vary between benign to malignancy. So, benign masses relate more to pain symptoms


However, malignant masses can be related more to non-specific symptoms like: 


  • Bloating;
  • Difficulty in eating and feeling full quickly;
  • Occasionally, of course, they can cause pain. 



What are the different types of ovarian masses?

Ovarian masses can be divided into five groups. 


Functional ovarian masses

These are the ones that have been part of the normal, natural cycle, with a little bit of derangement. For example, ovulation is known to happen every month. Sometimes the ovulation cyst can persist and cause what we call a corpus luteum. This can get slightly bigger with haemorrhage, but it's still a functional cyst. These ones are known to disappear on their own and can take a few weeks before they disappear completely. They don't need any specific treatment.



Benign masses

These benign masses are different to the functional ones; they shouldn't be there but they occur randomly as mentioned previously, and they can cause problems if they grow bigger than five centimetres. They're very common and they can be treated differently depending on the size and depending on the symptoms. 



Cancer type, which are either invasive or primary

This means the cancer's happening now and not coming from another organ, or can be metastatic. That means it can happen in another organ and metastasise to the ovaries. These cancer groups are known to metastasise either via the peritoneal surface or metastasise in the blood. These need to be treated in a cancer centre



A borderline is not benign and not cancer; it's in between. They don't metastasise like a cancer but they can come back if they aren't removed in the right way. They had the potential to convert into cancer over time if they aren't treated.  



What is the likelihood that ovarian masses could become serious?

Most ovarian masses, luckily, are benign. It depends on age; the chance of malignancy goes up with age. In women with menopause, the chance of malignancy is higher. In women's lifetime, there's a chance of ovarian cancer. We estimate it to be about one in 70, to one in 80, in people's lifetime.


Now, one in 70 to one in 80 chances compared to one in 12 for breast cancer, for example, so it's much less. The incidence of ovarian cancer in the community is one in every 2,500 women, each year. So, compared to benign masses, this is a lot less because with benign masses there's a chance that one in 10 women will have some type of surgery because of an ovarian mass. That is much higher than the likelihood associated with malignancy.   



How are ovarian masses diagnosed?

There are a few ways to diagnose ovarian masses. First, with clinical symptoms and investigations, including some blood tests. Sometimes we ask for a tumour marker to see if there's a chance these ovarian masses to be cancerous. The most famous tumour marker is CA 125. 


The ultrasound scan is the golden tool of diagnosis. It characterises ovarian masses accurately in about 90 to 95 per cent. Sometimes the ultrasound scan isn't possible because we can't perform a transvaginal ultrasound scan, or the picture isn't very clear because of many different factors, like a big fibroid uterus. In that case, we can resort to an MRI


The MRI is the second option for characterising ovarian masses after ultrasound scan because it's more difficult to get, compared to the ultrasound scan, but it gives the same accuracy as the ultrasound scan in diagnosing the ovarian mass, whether it's benign, borderline or malignant. Other tests like a CT scan are useful when we want to see how much the cancer is disseminated into the lymph nodes or into other surfaces, or into the chest.



If you’re concerned about any ovarian masses that you may have, and whether they require further treatment, arrange an appointment with leading expert Mr Sayasneh via his Top Doctors profile.  

By Mr Ahmad Sayasneh
Obstetrics & gynaecology

Mr Ahmad Sayasneh is a highly experienced consultant in gynaecology and gynaecological oncology surgery. His range of specialist expertise covers, but is certainly not limited to, endometriosis, menorrhagia (heavy periods), pelvic pain, gynaecological cancer, colposcopy and gynaecological ultrasounds.

As a gynaecologist who is specialised in complex surgery, many of Mr Sayasneh's patients are referred by other gynaecologists because of his surgical expertise in advanced open and laparoscopic (keyhole) surgery. What’s more, he is an international expert in gynaecological ultrasonography who significantly contributes to the body of scientific evidence in gynaecological ultrasound examination including gynaecological and early pregnancy diagnostics using ultrasound.

After completing his initial medical studies in Damascus, Syria in 1998, he relocated to London to continue his training. This includes obstetrics and gynaecology training with a subspecialty in gynaecological oncology at the London Deanery, Hammersmith Hospital. He continued to further hone his skills at Cambridge University Hospitals through advanced training in vaginal surgery for benign diseases, which ultimately provided him with expertise in reconstructive vaginal surgery. His participation in prestigious international fellowships in the Czech Republic, Italy and Syria has given him a great wealth of knowledge and experience in different aspects of his field that he uses to provide patient care of the highest quality. His training lead to a specialist interest in the management of vulval atrophy and lichen sclerosis. At the British Society for Colposcopy and Cervical Pathology, he underwent colposcopy training and was accredited as a colposcopist.

Since 2015, Mr Sayasney has worked at the Guy’s and St Thomas’ NHS foundation trust. He also attends to private patients’ needs at the Guy’s and St Thomas’ Hospital, 132 Harley Street, London Bridge Hospital (The Shard), BMI the London Independent Hospital and at Weymouth Street Hospital. Furthermore, he is a member of various British, European and international societies of obstetrics, gynaecology and gynaecological oncology.

Not only does he dedicate his career to patient care and consistently staying up to date with the latest medical techniques in his field, but he also teaches future generations of gynaecological consultants. He is an honorary senior clinical lecturer (research) in the Faculty of Life Sciences and Medicine, King’s College London as of 2016 and at the Department of Surgery and Cancer since 2015. He contributes to research greatly and has a long track of publications with more than 40 scientific papers in international peer-reviewed journals. He has authored 2 chapters (Grey’s Anatomy and Ovarian cysts) and he is currently editing a book on gynaecological ultrasound. He has an h-index of 17 with Google scholar. His achievements have lead him to be invited to speak and chair at several international meetings on subjects relating to the use of ultrasound and diagnostics in gynaecology.

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