Ovarian Diseases

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of reproductive-age women, affecting nearly 5%‒10% of women in the age group. Characterized by hyperandrogenism, chronic anovulation leading to oligomenorrhea (or amenorrhea), and metabolic dysfunction, PCOS increases a woman’s risk for infertility, endometrial hyperplasia or carcinoma, and cardiovascular disease. The pathophysiology is incompletely understood but thought to have a multifactorial genetic basis causing altered pulsatile release of gonadotropin-releasing hormone (GnRH), as well as increases in luteinizing hormone (LH), androgens, estrogen, and insulin: The result is chronic anovulation and hirsutism, which define the condition. Diagnosis is one of exclusion; therefore, other causes of abnormal uterine bleeding and hirsutism must be ruled out. Management includes attempting to restore normal ovulation through weight loss, oral contraceptive pills (OCPs), and fertility assistance.

Ovarian cancer is of epithelial origin in 60% of the patients. Most patients present at an advanced stage due to the lack of specific symptoms except for mucinous ovarian cancer where abdominal distension is so severe that patients present very early in the disease. Once ovarian cancer is suspected, the patient usually undergoes a transvaginal ultrasonography, abdomen-pelvic CT scan and CA-125 concentration measurement. If an ovarian cyst or mass is identified, its characteristics will be noted and a risk of malignancy index can be calculated. Treatment involves neoadjuvant platinum-based chemotherapy with or without surgery. Newer treatments include antiangiogenic antivascular endothelial growth factor bevacizumab and pazopanib.

Ovarian cancer is becoming challenging every year due to the ever increasing number of new diagnoses. It is considered the 5th leading cause of cancer deaths among women; with about 14,000 deaths and more than 20,000 new cases every year.

During pregnancy, it is possible for the tissue surrounding the embryo to degenerate. Such degeneration typically manifests itself in hydatidiform moles and choriocarcinoma. These tumors are difficult to diagnose and are associated with an increased level of beta hCG. Treatment involves the complete removal of the tumorous growth. The characteristics of the tumors are described in more detail below.