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Post-Menopausal Women With Cystic Ovarian Cancer Not In Grave Danger, Says Study CHICAGO, IL -- May 5, 1998 -- Should a post-menopausal woman, over the age of 50, who has been diagnosed with cystic ovarian tumours, be alarmed? According to conclusions reached in a new study published in the April issue of Gynecologic Oncology, alarm is unwarranted, but concern is appropriate. The study was a co-operative effort between the division of gynecologic oncology and the department of statistics at University of Kentucky Medical Center, Lexington, KY. Early ovarian cancer rarely produces any discernible symptoms. Symptoms usually appear only when the cancer is at an advanced stage. Transvaginal sonography has demonstrated its effectiveness in screening for the disease, however, its positive predictive value (PPV) is low, requiring up to 10 women to have ovarian tumours removed in order to detect one case of ovarian cancer. Tumours are one of two types: unilocular tumours that have one compartment or cavity and tend to be benign; and complex tumours that have wall abnormalities and tend to have a significant risk of malignancy. The authors of this study set out to determine the potential for malignancy in tumours detected by ultrasound in asymptomatic post-menopausal women or women over 50 years of age. With this information, patient management strategies for operative intervention in this patient group could be devised. Patients included in this study had participated in the University of Kentucky Ovarian Cancer Screening Project from 1987 to 1995. All asymptomatic women who were at least, 50 years old and post-menopausal, were eligible to enrol in the research effort. Women with a known ovarian tumour or personal history of ovarian cancer were excluded from the study. Participating patients completed a medical history questionnaire. Transvaginal sonography (TVS) was performed on each, with repeat screening performed at varied intervals, according to the test results. During the eight year period, 7,705 asymptomatic postmenopausal women were screened. The results revealed unilocular cystic ovarian tumours in 256 women (3.3 percent), tumours with solid and cystic components (complex ovarian tumours) were present in 250 women screened. Key characteristics of each group follow: Women with unilocular cystic ovarian tumours: -- The mean age for this group of women was 55.5 years. A family history of ovarian cancer was found in 13.6 percent and 42 percent of the 256 women were taking prescribed hormone replacement therapy. -- Most of the cysts were located at the surface of the ovary and few were located centrally. All tumours were less than 10 centimetres (cm) in diameter with 90 percent of those found were less than 5 cm. -- 125 women (49percent) had tumours which resolved spontaneously within 60 days of detection. The balance of the women had tumours that persisted. Of the latter group, 45 women underwent laparoscopy or laparotomy with tumour removal and 86 elected to be followed with serial sonograms. There were no cases of malignancy found in the tumours removed or has ovarian cancer occurred in any of the women now receiving follow-up sonograms. Women with complex ovarian tumours: -- The mean age of the 250 women in this group was 59.1 years and 10 percent had a family history of ovarian cancer. Hormone replacements were being taken by 100 women. -- All of the tumours were less than 10 cm in diameter with 89 percent less than 5 cm. Of this group, 135 (55 percent) women had tumours that resolved spontaneously within 60 days of detection; 115 (45 percent) women had tumours that persisted. Some 114 of the 115 women with persistent complex ovarian masses underwent surgical removal of these tumours, 30 by laparoscopy and 84 by laparotomy. -- Seven patients had ovarian cancer, one patient had primary peritoneal cancer and one had metastatic breast cancer to the ovary. The frequency of malignancy in patients with complex ovarian tumours was 6.1 percent compared to 0 percent in patients with unilocular cysts. The authors said that post-menopausal women with unilocular cysts can be followed by sonograms at three to six month intervals. The researchers also believed that significant risk for malignancy recommends surgical removal as the preferred treatment for post-menopausal women with complex ovarian cysts. E-mail this page to a friend or colleague! To print, use this version