Ovarian masses and tumors

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 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 Children’s Vector blog.