Ovarian mass / ovarian tumor in adolescents

  • "We developed a technique for removing ovarian masses, even very large ones, by which we can save the ovary."

    Marc Laufer, MD, Chief, Division of Gynecology

    Ovarian masses in infants, young girls and adolescents are enlargements of the ovaries—the organs that store and release eggs, and that produce female hormones. These masses may be cysts or tumors, and if they’re tumors, they may be cancerous or benign (non-cancerous). Tumors and cysts can appear on one or both ovaries, individually or in clusters. Sometimes, ovarian cysts (fluid-filled sacs that usually dissolve after ovulation) cause pain, but most don’t cause any problems and go away on their own.

    • Ovarian tumors are the most common tumors that babies are born with, accounting for one percent of all malignant tumors found in children from birth to the time she’s 17.
    • In girls younger than 8, four out of five ovarian tumors are benign (non-cancerous). Your daughter may need to go to the Dana-Farber/Boston Children's Cancer and Blood Disorders Center for surgery, radiation or chemotherapy if the mass is cancerous.
    • All cancer should be taken seriously, but in children and adolescents, ovarian cancer has a much higher cure rate than adult forms of ovarian cancer.
    • Benign ovarian cysts may be cured by surgically removing or draining them, but new cysts may form in the future.
    • At Boston Children’s, almost 100% of children’s ovaries are saved when removing benign cysts or tumors.

    How Boston Children's Hospital approaches ovarian masses

    Helping girls and young women with ovarian masses is a specialty of ours, here at the Division of Gynecology here at Boston Children's Hospital. When a child has an ovarian mass, we know that it can be extremely worrisome, even if it’s benign. We understand the diagnosis of an ovarian mass needs to be quick and accurate, and we provide the highest quality of diagnostic services and treatment.

    The Division of Gynecology is home to the Center for Young Women's Health, an online resource for girls and young women with questions and concerns about gynecological issues, including ovarian tumors and cysts.

    If your daughter is diagnosed with a cancerous ovarian tumor, she can receive treatment at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center.  Dana-Farber/Boston Children’s Cancer and Blood Disorders Center combines the expertise of Boston Children's Hospital and Dana-Farber Cancer Institute to provide comprehensive medical and surgical care for girls with cancerous ovarian tumors.

    Ovarian masses and tumors: Reviewed by Marc Laufer, MD
    © Boston Children’s Hospital, 2012


  • In-Depth

    We understand that you may want to learn more about your child’s ovarian mass or tumor as an important step in getting her the best possible care. Here, you’ll find answers to several commonly asked questions, and when you meet with our experts, they can explain your daughter’s particular situation to you fully.

    What are ovarian masses and tumors?

    Until the mass in your daughter's belly is diagnosed and categorized, you won't know if it's a cyst, a tumor or even something unrelated, such as appendicitis.

    About ovarian cysts

    • A cyst is a fluid-filled sac that develops in the ovary and usually dissolves after ovulation.
    • Cysts are typically sacs containing liquid or some debris, and are also usually benign (non-cancerous).
    • It's normal for newborn baby girls to have cysts on their ovaries, which may be seen on prenatal ultrasounds.
    • These cysts may be as large as two inches in size after birth and still go away on their own without causing problems.
    • In adolescence, cysts may form in response to fluctuating hormone levels.
    • Complications from the cysts can include:
    • ovarian torsion
    • It blocks the blood from going to the ovary.
    • If this were to happen, you would have severe abdominal pain and you might feel like throwing up or even feel like passing out.
    •  If you have any of these symptoms, you should see your doctor immediately or go to the closest hospital emergency room.
    • rupture
    • When the cyst ruptures, it may cause severe pain and lead to internal bleeding.  Internal bleeding can be fatal, and requires immediate emergency room care. 
    • Types of cysts
      • functional cysts
        • most common type of cyst
        • normally occur as a result of ovulation
        • usually shrinks within 60 days
        • two types of functional cysts
          • follicular cyst
            • When the follicle fails to rupture and release an egg during the midpoint of the menstrual cycle, it forms a cyst.
          • corpus luteum cyst
            • After the follicle releases the egg, the follicle closes back up, trapping fluid and forming a cyst.
            • After the follicle releases the egg, the follicle usually stays open.  In cases the follicle does not stay open and it closes back up, this traps the fluid and forms a cyst.
      • polycystic ovaries
        • egg follicles fail to form, and become cysts
        • in some cases, many cysts develop inside the ovary
        • harmless and painless
      • endometriomas
        • uterus lining tissue in the ovaries
        • very painful and can affect a woman’s fertility
      • cystadenomas
        • on the surface of ovaries
        • filled with watery liquid or a mucous material
      • dermoid cysts
        • tissues such as skin, hair and teeth grow in the ovary because they form cells that produce human eggs
        • rarely cancerous
        • usually occur in women from ages 20 and 40

    Ovarian tumors:

    • Ovarian tumors are non-cancerous (benign) or cancerous (malignant) lumps of cells on the ovaries.
    • Early diagnosis of an ovarian tumor is important so that any (potential) cancer can be treated early.
    • An ovarian mass that appears innocent and doesn't cause symptoms may be kept under observation.
    • Types of tumors
      • epithelial cell tumors
        • most common type
        • develop from the ovaries’ surface
      • germ cell tumors
        • develop in the egg producing cells
        • most are benign, few are cancerous
      • stromal tumors
        • develop in the female hormone producing cells

    Can a cyst become a tumor?

    Yes. There are different kinds of cysts: functional cysts and non-functional cysts. Non-functional cysts do not go away and are not associated with a woman producing egg an each month. They can either be benign or develop to be malignant.

    What are ovaries?

    Women have two, small, grape-shaped organs called ovaries inside of her abdomen (belly) on either side of her uterus. When a girl is born, her ovaries are already filled with millions of eggs. When she reaches puberty, chemical signals from the pituitary gland in the brain “tells” the ovaries to ripen an egg. Usually once a month, an egg is released from a fluid filled sac in the ovary so it can travel through the fallopian tube to the uterus. This is called ovulation which is part of a woman’s monthly cycle.

    What’s the difference between a tumor and a cyst?

    • Cysts are more likely to be benign than tumors are.
    • Tumors are a more solid mass of tissue, while cysts are filled with fluid, tissues, or other materials.

    Can ovarian cysts be prevented?

    If a woman has a large ovarian cyst or a history of developing ovarian cysts, a health care provider may prescribe birth control pills to prevent her body from ovulating. This lowers her chances of forming new cysts in the future, but doesn’t make the cyst she already has go away any faster. If you or your daughter wants to learn more, talk to your health care provider about birth control pills.

    Are they curable?

    Benign ovarian cysts may be cured by surgically removing them, but new cysts may form in the future.Patients may need follow-up testing with ultrasound due to the risk of additional cysts forming in the future.

    How serious are cysts if they’re non-cancerous?

    A non-cancerous ovarian cyst usually doesn’t cause any problems, but occasionally it may cause the ovary to twist on its root. This is called “torsion” and it  blocks the blood from going to the ovary.

    How serious are they if they’re cancerous?

    All cancer should be taken seriously, but in children and adolescents, ovarian cancer has a much higher cure rate than adult forms of ovarian cancer.

    Causes

    What causes ovarian masses?

    • The cause of ovarian tumors in infants and children is unknown. In adolescence, ovarian cysts can develop in response to fluctuating levels of female sex hormones during the menstrual cycle.
    • For more information on how ovarian tumors develop, see: Germ cell tumors.

    What are some risk factors for ovarian cancer?

    • inherited gene mutations
    • breast cancer gene 1 (BRCA1)
    • breast cancer gene 2 (BRCA2)
    • family history of ovarian cancer
    • previous cancer diagnosis

    Symptoms

    What are the symptoms of ovarian masses?

    A girl with an ovarian tumor may have no specific symptoms. However, depending on the size, location and type, it may cause some the following symptoms:

    • a feeling of pressure or fullness in the abdomen or pelvis
    • a firm, painless swelling in the lower abdomen
    • frequent urination or retention of urine
    • persistent abdominal pain
      • Sometimes ovarian cysts will cause pain from bleeding or twisting.
    • nausea
    • vomiting

    Among girls younger than 8, an ovarian tumor or cyst may cause secretions of estrogen, producing:

    • breast enlargement
    • pubic hair
    • vaginal discharge or bleeding
    • abnormal menstrual bleeding

    If you or your daughter has belly pain that doesn’t go away or irregular periods, tell your health care professional.

    FAQ

    Q: My child has a pain on her side every month or so, is this normal?

    A: Some women experience pain on one side or the other below their belly button about two weeks before they get their periods. Others do not. This is called “mittlesmirtz,” which means pain or discomfort with ovulation. This kind of pain is mild to moderate and usually lasts anywhere from one hour to one to two days. But if you have severe pain, it could be caused from other problems so you should check with your health care provider or go to an emergency room.

    Q: Are ovarian cysts common?

    A:Ovarian cysts can be common in girls and women who have started their periods.

    Q: How likely is an ovarian tumor to be cancerous?

    A:In girls younger than 8, one out of five ovarian tumors are cancerous.

    Q: Can my daughter still have a child of her own if an ovary is removed?

    A:Yes. In the rare case that an ovary has to be removed, your daughter can still have a child if one of her ovaries is removed.

    Q: Is my daughter going to be OK if she has a cyst?

    A: An ovarian cyst usually doesn’t cause any problems, but occasionally it may cause the ovary to twist on its root. This is called “torsion”. Torsion blocks the blood from going to the ovary. If this were to happen to your daughter, she would have severe abdominal pain and you might feel like throwing up or even feel like passing out. If your daughter has any of these symptoms, she should see her doctor immediately or go to the closest hospital emergency room.

    Q: Is my daughter going to be OK if she has a tumor?

    A:In girls younger than 8, four out of five ovarian tumors are benign, but your daughter may need surgery, radiation or chemotherapy if the mass is cancerous.

    Q: Can my child still exercise if she has an ovarian cyst?

    A:Your health care provider might recommend your daughter not to exercise or participate in sports until the cyst becomes small or goes away completely. This is because vigorous activity might cause her ovary to twist on itself which is a condition that requires emergency care.

    Q: Can children have ovarian cancer?

    A:Yes. Children, specifically girls, can have ovarian cancer. Most ovarian cancers in children and teens can be treated with surgery and close observation.  Rarely chemotherapy is needed and the Dana Farber Cancer Center, which is affiliated with Boston Children’s, offers several resources for treating and coping with ovarian cancer.

    Q: Can ovarian cancer be contagious?

    A:No.

    Q: What are potential long-term health consequences?

    A: As long as the ovary is saved, there are generally no long term issues except the need for follow up surveillance with ultrasound due to the risk of additional cysts or tumors forming in the future. When it comes to removal of benign masses or tumors, almost 100 percent of ovaries are saved. In the rare case in which an ovary is permanently removed, a woman can still get pregnant with one ovary.

    Questions to ask your child’s doctor

    After your child is diagnosed with an ovarian mass, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you.

    Lots of parents find it helpful to jot down questions as they arise- that way, when you talk to your child’s doctors you can be sure that all of your questions are concerned. If your child is old enough, you may want to suggest that she writes down what she wants to ask her health care provider too.

    Here are some questions to get you started:

    • How may the medications or treatmentimpact my child’s life, including academic performance?
    • How may the medications or treatment interact with my child’s current medication regiments?
    • Will my child’s daily activities need to change if she needs surgery or chemotherapy?
    • Can my child receive medication for any pain that may result from the cyst or tumor?    
    • What support services are available to educate my child about her ovarian cyst or tumor?
    • What are some good strategies to communicating with my daughter about her ovarian cyst or tumor?
    • If surgery is necessary, how can I prepare my child?
    • How can I tell if the symptom is for ovarian cyst or tumor, or something else?
    • Are there any precautions my child should take as she grows up to reduce the risk of infertility?
      A look at cancer drugs of the future: Smart drugs
      Ovarian cancer can be caused by a several genetic factors, including a BCRA1 gene deletion.  This gene is one the genes from which researchers are learning about genetic aberrations. Genetic aberrations, or deletion of genes, are a clue to developing drugs that can learn as the cancer grows, and be “smart” enough to adjust. Read more on Boston Children’s Vector blog.
  • Tests

    The first step in treating your child is forming an accurate and complete diagnosis.

    How are ovarian cysts diagnosed?

    Because most ovarian cysts don’t cause symptoms and go away on their own, they may go completely unnoticed. If you have pain or irregular periods that prompt you to see your health care provider, you may need to have a pelvic ultrasound to see if you might have a cyst. If you have a cyst, it will be visible on the ultrasound.

    • Pelvic ultrasound
      • One of the first tests performed is usually a pelvic ultrasound.
      • A pelvic ultrasound uses sound waves to make a picture of your reproductive organs (ovaries and uterus) and bladder (where your urine is stored).
      • It is usually necessary to have a full bladder before the procedure. This means you will need to drink a lot of water before you arrive for the test. The test itself is not painful but you may feel a little uncomfortable since your bladder will be full until you pass urine (pee) after the test.
      • You will lie on your back on an exam table while the technician places a warm gel on your lower belly with something that looks like a microphone.
      • The technician will gently move this microphone-like instrument over your belly. The instrument actually makes a picture by picking up sound waves.
      • From these pictures your doctor will know if you have an ovarian cyst. If you have a cyst, your doctor will most likely repeat the pelvic ultrasound in about 2-8 weeks to make sure that the cyst is getting smaller or gone completely.
      • The tumor is probably not cancerous if the ultrasound shows an ovarian cyst filled with clear fluid.
      • If it shows debris in the cyst fluid, or if the tumor has solid parts, then more tests are needed.
    • Other tests
      • laparoscopy
        • a surgical procedure that allows the examination of the interior of the abdomen using a special instrument called a laparoscope
        •  used to determine size, grade and the stage of the tumor.
      • biopsy
        • a surgical procedure that involves removal and laboratory analysis of a small portion of the tumor
      • urine and blood tests
      • computerized tomography scan (also called a CT or CAT scan).
      • pregnancy test
        • If a women is pregnant and has a cyst,  the cyst is likely is a corpus luteum cyst, which is formed when the ruptured follicle releases the egg, and reseals itself and fills with fluid.
        • Corpus luteum cysts is a type of functional cyst and is harmless to the women and does not negatively affect pregnancy. 

    After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. Then we will meet with you and your family to discuss the results and outline the best treatment options.

     Red Sox themed CT suite and CAT Scan
    A computed tomography scanner or CAT Scan machine can be an intimidating piece of machinery, especially for a child. Boston Children’s Hospital designed the CT Scan room with a baseball diamond designed floor, and pictures of Red Sox fans -- doctors, nurses, and technologists included -- among the Muppet-like figures in the "stands" on the walls. Learn more about the Red Sox Theme CT suite and CAT scan

     

    Interdisciplinary approach to ultrasound
    Learn how Boston Children’s radiologists work with an interdisciplinary approach to ultrasounds, leveraging the expertise and experience of other medical professionals to foster innovation and promote safe sonographic techniques.
  • Undoubtedly, you were distressed when you learned that your daughter has an ovarian mass. That's understandable – no parent wants his or her child to be unwell. But at Boston Children's Hospital, we view the diagnosis as a starting point. Having identified your daughter's condition, we're able to begin the process of treating her, so that we may ultimately return your daughter to good health.

    Division of Gynecology

    The Division of Gynecology at Boston Children's brings more than three decades of expert knowledge to the diagnosis and treatment of more than 30 different conditions, including ovarian cysts and tumors. In order to diagnose, treat and care for our young patients, we take a collaborative interdisciplinary approach, teaming up with experts from the General Surgery Program, the Department of Urology, the Division of Adolescent/Young Adult Medicine, the Division of Endocrinology and the Gender Management Service Clinic.

    Ovarian mass treatment at Children's

    At the Gynecology Program at Boston Children's Hospital, our team brings expert knowledge to the diagnosis and treatment of your daughter's ovarian cyst or tumor.

    Our researchers are constantly searching for new, effective therapies. In conjunction with the Department of Pediatric Oncology and the Dana Farber Cancer Center, the Department of Surgery participates in several national studies that are looking into more effective ways to treat girls with ovarian tumors that involve the least surgery possible.

    Ovarian cyst treatment:

    Most ovarian cysts go away without any treatment. In the case that it doesn't, draining or removal may be necessary.

    • Draining: If your daughter has a cyst bigger than two inches across, it may need to be drained with a needle to keep it from twisting and pinching off the ovary's blood supply.
    • Removal: Sometimes an ovarian cyst may not go away and needs to be removed. In this case, a surgeon would remove the cyst while leaving the rest of the ovary in place.

    Ovarian tumor treatment:

    Treatment of ovarian tumors during childhood and adolescence is complex and delicate process. The physician needs to eliminate the tumor and, if possible, preserve your daughter's ability to have children. If the tumor is benign (non-cancerous), your surgeon may be able to remove it and keep the rest of the ovary alive, but usually, the entire ovary needs to be removed.

    Successful treatment of your daughter's malignant (cancerous) ovarian tumors at the Dana Farber Cancer Center may involve a combination of the following:

    • Surgical removal of tumors or involved organs
      • Debulking: If the ovarian cyst growth is cancerous, and the cancer has spread far, the ovaries, uterus, fallopian tube, fatty tissue covering the intestines (omentum) and lymph nodes may be removed.
    • Chemotherapy, a drug treatment that works by interfering with the cancer cell's ability to grow or reproduce.
      • Often, a combination of chemotherapy drugs is used to fight a specific cancer. Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat.
      • Often happens after removal of tumor and involved organs
      • While chemotherapy can be quite effective in treating certain cancers, the agents don't differentiate normal healthy cells from cancer cells. Because of this, there can be many adverse side effects during treatment. Being able to anticipate these side effects can help the care team, parents and child prepare, and, in some cases, prevent these symptoms from occurring, if possible.
      • Side Effects
        • red skin
        • nausea and vomiting
        • hair loss
        • kidney damage
        • risk for infection
    • Radiation therapy, or the use of high-energy X- rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors.
      • Side Effects
      • red Skin
      • nausea
      • diarrhea 

     About Dana Farber/Boston Children's Hospital Cancer and Blood Disorders Center:

    Our multidisciplinary approach to care ensures in-depth discussion of each case and personalized treatment plans for every patient. We integrate expertise from the following specialists:

    • pediatric oncologists, surgical oncologists and radiation oncologists
    • pediatric experts from every medical subspecialty
    • highly skilled and experienced pediatric oncology nurses
    • child life specialists, psychologists, social workers and resource specialists who provide supportive care for your child before, during and after treatment

    In addition, our cancer center offers the following services:

    • Expert diagnosis by pathologists using advanced molecular diagnostic testing to identify your child's type of tumor. Knowking the molecular composition of a tumor helps predict which treatments are more likely to work.
    • Acess to unique Phase I clinical trials, from our own investigators, and from the Child's Oncology Group.
    • Expert surgical care from experienced pediatric surgeons, several of whom developed approaches used at centers across the country.
    • Support services to address all of your child and family's needs.
      Choosing treatment options: Chemotherapy and radiation

      Chemotherapy and radiation are the most powerful treatment options if your child's ovarian tumor is cancerous. Chemotherapy is a category ofdrug treatments that works by interfering with the cancer cell's ability to grow or reproduce. Radiation is the use of X-rays to kill cancer cells. Learn more about the pros and cons of both treatment options from Lisa Diller, MD, clinical director of Pediatric Oncology at Dana-Farber/Children's Hospital Cancer Center. http://www.youtube.com/childrenshospital#p/search/35/ukN66mE8rms

     

    Coping & support

    Peer-to-peer advice for young women

    Your daughter will face unique challenges with the diagnosis of an ovarian mass or tumor. Sometimes advice coming from a peer or a role model closer in age is more effective than coming from a parent. Part of the Center for Young Women's Health is the Youth Advisor group, made up of two high school students and a college student all from Boston, offering peer to peer advice on health topics for young women.

    The Center for Young Women's Health (CYWH) is joint initiative between the Division of Adolescent & Young Adult Medicine and the Division of Gynecology at Boston Children's Hospital. The Center is an educational entity that exists to provide teen girls and young women with programs, health information, and information on medical care options if necessary.

    Create Your Children's Carepage

    Keep family and friends up to date during your child's treatment by creating a free Boston Children's Carepage.

    Adolescent Medicine

    Ovarian masses and tumors often impact young women in their teenage years. In combination with the usual psychological challenges of adolescence, having a condition of reproductive system is especially challenging. Learn how Children's Division of Adolescent Medicine helps your daughter not only as a patient, but as an individual person with unique challenges as she faces her condition.

    For parents and guardians

    Polycystic ovary syndrome (PCOS) is a hormone imbalance that can cause irregular periods, unwanted hair growth and acne. The unwanted hair growth and acne may be challenging for your daughter to cope with. Fortunately, a healthful diet and exercise can help make PCOS symptoms go away. Encourage your daughter to choose high-fiber carbohydrates, protein, healthy small meals and snacks and regular exercise. Learn more about how to help your daughter cope with PCOS on the “For Parents” page of the Center for Young Women's Health website.

    Taking on cancer with a smile

    Learn how the Dana-Farber/Children's Hospital Cancer Center staff helped to keep Ariana's cancer in remission. Join the conversation on Children's Thriving blog.

     

    Online health chats for your teenage daughter

    Having an ovarian mass or tumor may be something your daughter doesn't want others to know about, but it is helpful to share experiences with peers. Children's has come up with a solution for children to be able to anonymously share experiences with each other with different conditions.   Learn how your daughter can join the online health chats ran by Children's nurses and doctors.

  • Research & Innovation

    At Children’s Hospital Boston, we develop treatments that are informed by our scientific research. We are home to the world’s most extensive research enterprise at a pediatric hospital.

    Ovarian neoplasms

    In 2007, the Division of Gynecology completed a retrospective study to show the advantage of conservative surgical management of large ovarian neoplasms (tumors) in adolescents. The purpose of the study was to find the best way to remove large benign cysts from ovaries, while maximizing the reproductive potential of the patients. Reinforcing the reliability of the results, the same surgeon performed all nine of the ovarian cystectomy surgeries using a uniform technique for each patient.

    Using ultrasound, the researchers found that the majority of the ovaries returned to the same size after the surgery as it was pre-operatively. Additionally, no surgical complications occurred.  The results also showed that gynecology surgeons were 15 times more likely to preserve the ovary than pediatric general surgeons. Marc Laufer, MD, chief, Division of Gynecology, of Boston Children’s, Boston Children’s is a specialized gynecology surgeon, but also has experience working with children, thus having both the technical surgical expertise and pediatric care experience.

    Patents and cancer research

    The American Civil Liberties Union lead a lawsuit against Myriad Genetics and the U.S. patent system, claiming that patents on the genes connected to hereditary ovarian and breast cancers gives Myriad Genetics a monopoly on drug development, and may raise drug costs. Contrary to this position, there is also the argument that patents serve as an incentive for pharmaceutical companies to research cancer and develop new drugs and treatments. The colliding economic, ethical and legal aspects of this issue are important to discuss and understand. Read more and join the conversation on Boston Children’s Vector blog.

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