Ovarian malignancy is a serious disease affecting women of all ages, more so above 50 years, and they are still difficult to treat, partly because no truly effective therapy has yet been developed although presentation is often vague and non-specific, the symptoms are definitely present. It is important to recognize the symptoms so far, there is no test yet available, which is truly specific and suitable for screening and early detection of epithelial ovarian carcinoma. So, it is concluded that for prognosis and patient survival, early detection and treatment is mandatory

Jabeen, Nigar

Muhabat, Qamarunissa

Unissa, Waqar

Waheed, Fakharunissa

English

eCommons@AKU

eCommons@AKU Department of Obstetrics & Gynaecology Division of Woman and Child Health 3-2016 Clinical presentation of ovarian tumors Qamarunissa Muhabat Fakharunissa Waheed Waqar Unissa Nigar Jabeen Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_obstet_gynaecol  Part of the Maternal and Child Health Commons, and the Obstetrics and Gynecology Commons Open Journal of Obstetrics and Gynecology, 2016, 6, 205-209 Published Online March 2016 in SciRes. http://www.scirp.org/journal/ojog http://dx.doi.org/10.4236/ojog.2016.64026    How to cite this paper: Muhabat, Q., Waheed, F., Waqarunissa and Jabeen, N. (2016) Clinical Presentation of Ovarian Tu-mors. Open Journal of Obstetrics and Gynecology, 6, 205-209. http://dx.doi.org/10.4236/ojog.2016.64026    Clinical Presentation of Ovarian Tumors Qamarunissa Muhabat1, Fakharunissa Waheed2, Waqarunissa3, Nigar Jabeen4 1Department of Obstetrics & Gynecology, Aga Khan Maternity & Child Care Hospital, Hyderabad Sindh,  Pakistan 2Department of Obstetrics & Gynecology, Indus Tando M. Khan, Hyderabad Sindh, Pakistan 3Department of Obstetrics &Gynecology, Isra University Hospital, Hyderabad Sindh, Pakistan 4Department of Obstetrics & Gynecology, Aga khan Maternity & Child Care Hospital, Hyderabad Sindh, Pakistan       Received 9 February 2016; accepted 14 March 2016; published 17 March 2016  Copyright © 2016 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/      Abstract Ovarian malignancy is a serious disease affecting women of all ages, more so above 50 years, and they are still difficult to treat, partly because no truly effective therapy has yet been developed al-though presentation is often vague and non-specific, the symptoms are definitely present. It is important to recognize the symptoms so far, there is no test yet available, which is truly specific and suitable for screening and early detection of epithelial ovarian carcinoma. So, it is concluded that for prognosis and patient survival, early detection and treatment is mandatory.  Keywords Ovaries, Ovarian Tumor, Clinical Presentation   1. Introduction Ovarian tumor is one of the most common gynecological tumors seen in female although there are different types of ovarian tumor but epithelial ovarian cancer is the fifth most common cause of cancer death in women [1]. In Pakistan, it is the 2nd most common cause of death in women malignancies after breast tumor [2]. It is often called the “silent killer” because the disease is not often detected until it reaches an advance stage. Due to its anatomical location, such ovarian tumors may remain unnoticed for a long period of time [3] [4]. Ovarian cancer usually affects the age of 65 years or older more frequently than younger women [1], they are not always malignant, but, the incidence of malignancy is about 15% - 25% in different parts of the world [5]. The incidence is high in North America and Europe as compared to Japanese [6]. These tumors behave in di-verse ways and are generally not detected until they get large size [7]. Ovarian tumors may be cystic or solid in consistency. Most of the benign tumors are cystic but 80% of solid ovarian tumors are malignant [3] [8].  Q. Muhabat et al.   206 There are a number of risk factors associated with their origin. None of these has been yet proved except for age and parity [9]. The relative risk for ovarian malignancy increases significantly after the age of 40 years [10]. An early menarche and late menopause are associated with an increased risk [11]. Use of oral contraceptive is associated with a reduced risk of benign ovarian neoplasma [12]. Common symptoms include abdominal disten-sion, abdominal and pelvic pain, and dyspepsia and also increased the frequency of urine [13]. Family history of ovarian and breast cancer has strong link and considers as major risk factor for ovarian cancer [14] [15]. One theory is that ovarian carcinoma arises from endometriosis; it is the presence of endometrial tissue rather than uterus [16]. 2. Data Collection Procedure Patients who had fulfilled the inclusion criteria were included in study; coming from OPD then informed con-sent was taken from patient. Details of the patient’s symptoms were recorded on pre-designed Performa. Demo-graphic profile including age, address, and parity was noted. A detail of symptoms was asked by researcher.  Symptoms which has been asked from patients include abdominal pain, abdominal mass and abdominal en-largement. Details of gastrointestinal symptoms like nausea, vomiting and urinary symptoms like increase in urinary frequency were asked. Constitutional symptoms including weight loss was asked. Then diagnosis is con-firmed by ultrasound or laparotomy and histopathology. Data Analysis All the information has been entered in the proforma attached as annexure by the researcher and analyzed by using SPSS version 15.0. 3. Results This case series study was conducted in the department of Obstetrics & Gynecology, Isra University Hospital, to determine the frequency of various clinical presentations of ovarian tumors by age and stage of disease. Total 97 women with various clinical presentation of ovarian tumor were enrolled in this study based on in-clusion & exclusion criteria. All the women were distributed and results are shown in the systemic order. In my study majority of women i.e. 37 (38.1%) belonged to age group >60 years while 17 (17.5%) belonged to <30 years (Table 1). Regarding the duration of symptoms i.e. 18 (18.6%) women has symptoms of less than 6 months while 42 (43.3%) women had symptoms for more than 1 year (Table 2). Table 3 shows that major-ity of women i.e. 47 (48.5%) were nullipara while 21 (21.6%) were multipara. In my study majority of wom-en i.e. 43 (44.3%) had abdominal mass & 19 (19.6%) had increased urinary frequency, while 19 (19.6%) were  Table 1. Frequency of age groups of study participants (n = 97).                                                            Age group Frequency Percentage <30 years 17 17.5% 30 - 40 years 11 11.3% 41 - 50 years 15 15.5% 51 - 60 years 17 17.5% >60 years 37 38.1% Total 97 100.0%  Table 2. Duration of symptoms (n = 97).                                                                                                               Duration Frequency Percentage <6 months 18 18.6% 6 months to 1 year 37 38.1% >1 year 42 43.3% Total 97 100.0% <6 months 18 18.6% 6 months to 1 year 37 38.1% Q. Muhabat et al.   207 asymptomatic (Table 4). Table 5 shows the stage of ovarian tumor i.e. 77 (79.6%) patients had benign tumor while 20 (20.6%) patients had malignant ovarian tumor. 4. Discussion Early diagnosis of ovarian cancer is challenge to gynecologist, mainly due to the fact that symptoms in early disease are vague and non-specific. Several studies have shown that women with ovarian cancer experience ab-dominal, GIT & constitutional symptoms, more as compared to those with benign tumors [17] [18].  In my study, 19.6% patients were asymptomatic while the result of study conducted by Wasim T. shows that 11% patients were asymptomatic [3]. Ovarian cancer is common in low parity & infertile women probably due to incessant ovulation theory. In my study, 48.5% women who had ovarian tumor were nullipara while 21% multipara. However in study conducted by khan I, at KEMU/Lady Willington hospital, 58.15% women who had ovarian tumor were multipara [19]. In another population based case control study, Titus Ernstaff et al. found that risk of ovarian tumors was higher in multiparous [20], a woman which is comparable to results of my study.  Another study conducted by Naheed A. Malik shows the percentage of weight loss is 4%, these findings are similar to the present study [5]. Delay in presentation is one of the big dilemmas with ovarian cancer & is re-sponsible for high mortality associated with disease. Similar delays have been reported in other studies [21] [22]. In my study, 43% presented with ovarian tumor after 1 year of development of symptoms reason of delay were non-specific symptoms, inadequate health care system, omission of pelvic examination at presentation,   Table 3. Parity of women (n = 97).                                                                                                               Parity Frequency Percentage Nullipara 47 48.5% Primipara 29 29.9% Multipara 21 21.6% Total 97 100.0%  Table 4. Frequency of various symptoms of study participants (n = 97).                                                        Symptoms Frequency Percentage Asymptomatic 19 19.6% Abdominal mass 43 44.3% Increased urinary frequency 19 19.6% Nausea 10 10.3% Vomiting 2 2.1% Weight loss 4 4.1% Total 97 100.0%  Table 5. Stage of ovarian tumor (n = 97).                                                                              Stage Frequency Percentage Benign 77 79.3% Malignant 20 20.6% Malignant stage I 7 7.2% Malignant stage II 5 5.1% Malignant stage III 3 3.09% Malignant stage IV 5 5.1% Q. Muhabat et al.   208 illiteracy & poverty. 5. Conclusion Ovarian tumor can affect peri- and postmenopausal women. The peak incidence is above 50 years of age. The women having history of malignancy in family should screen regularly specially in old age. So, it is concluded that for prognosis and patient survival, early detection and treatment is mandatory, which may reduce mortality. There is need to increase awareness of population. Abdominal and pelvic bimanual examination should be car-ried out in every patient presenting with gynecological problem and appropriate investigations in post meno-pausal women in early period to diagnose the disease at an early stage. 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Clinical presentation of ovarian tumors

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Clinical presentation of ovarian tumors

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