Ovarian tumours- premenopause

Question 1

IOTA classificaton of ovarian cysts

Answer 1

• insert table

Any M signs- refer to gynae onc

Question 2

RMI

Answer 2

RMI = U x M x CA-125.

• U - multilocular cysts, solid areas,
  metastases, ascites and bilateral lesions. U = 0 (for an ultrasound score of 0), U = 1 (for an ultrasound score of
  1), U = 3 (for an ultrasound score of 2–5).
• The menopausal status is scored as 1 = premenopausal and 3 = postmenopausal.
• Serum CA-125.

Question 3

Presentation of ovarian cyst

Answer 3

• Pelvic or IF pain
• Ask about red flags- wt loss, bloating, appetite change

Question 4

Investigations

Answer 4

• TV USS
• CA 125 - if simple cyst, not req.
• LDH, AFP, HCG - for all women <40 with a complex mass
  High risk of germ cell tumour
• MRI- only if concerns about malignancy

Question 5

Mx of simple ovarian cyst pre-menopause

Answer 5

• If <5cm, no f/u needed, usually resolve in 3/12.
• 5-7cm- yearly USS, if not resolving/pain- Lap removal/MRI.

Question 6

Surgical mx of benign cyst

Answer 6

• Laparoscopy&raquo_space; laparotomy
• Cystectomy&raquo_space; aspiration
• Try to limit spillage
• Drain cyst in a bag then remove whole
• Discuss possiblity of loosing the ovary