18: Pelvic mass

Question 1

DDx pelvic mass

Answer 1

Reproductive tract

• Pregnancy: ectopic
• non preg: cyst, benign tumour, fibroid, abscess, cancer, metastasis

GI: bowel cancer, faeces
Uro: renal mass, malignancy

Question 2

Hx pelvic mass

Answer 2

• Pain
• LMP, bleeding, discharge, start of menses/onset of menopause
• Associated sx: bloating, n&V, change in bowel habit, frequency, urgency
• Obs: parity, b reast feeding
• Gynae: fibroids, pcos, surgery
• FHx: breast, colon, endometrial
• SHx: smoking, drugs, alcohol

Question 3

Which tumour markers are used to investigate ovarian masses?

Answer 3

Ca125 (ovarian), CEA (bowel), Ca19-9 (pancreatic)

Question 4

What are the components of the RMI?

Answer 4

U = USS score
M = menopausal status
x Ca 125

Question 5

80% of ovarian cancer occurs > ___ years old and highest rates in ____ years old

Answer 5

50 years old

80-84 years old

Question 6

Risk factors for ovarian cancer

Answer 6

Relate to unsuppressed ovulation

• Menses: early onset, late menopause
• Obs: nulliparity, absence of breast feeding
• FHx: ovarian, breast, colon cancer

Question 7

Main histological types of ovarian cancer?

Answer 7

90% epithelial (high grade serous most common)

Question 8

Common presenting symptoms of ovarian cancer

Answer 8

Bloating, change in bowel/bladder habit, malaise, early satiety

Mets -> liver (jaundice) peritoneum (distension) or lung (haemoptysis)

Question 9

Staging of ovarian cancer

Answer 9

1. Confined to ovaries
2. Confined to pelvis
3. Confined to abdomen
4. Extra abdominal