Pelvic Mass Flashcards
Clinical presentation of uterine fibroids?
Asymptomatic Menorrhagia Pelvic pain Pain/tenderness - only disproportionate if red degeneration Pressure symptoms
What is red degeneration (carneous degeneration) of fibroid?
Haemorrhage in centre of fibroid causing disproportionate pain and tenderness
Who gets uterine fibroids?
Afro-carribean
Over 40 years
Investigation for fibroids?
FBC - Hb levels
Ultrasound - diagnostic
Treatment of fibroid?
Asymptomatic - expectant Hysterectomy Myomectomy Uterine artery embolisation Hysteroscopic resection
What are some conditions (4) that cause tubal swellings?
Ectopic pregnancy
Hydrosalpinx
Pyosalpinx - acute/ inflammatory
Paratubal cysts - embryological remnant
What are functional cysts?
Related to ovulation - follicular/ luteal cysts
Clinical features of endometriosis?
Severe dysmenhorrhea Premenstrual pain Dysparenuia Subfertility Endometriomas - can rupture
Which primary ovarian tumours arise from surface epithelium?
Serous Mucinous Endometrioid Clear cell Brenner
Which primary ovarian tumours arise from germ cells?
Benign cystic teratoma AKA dermoid cyst
Malignant germ cell tumours - rare
Which primary ovarian tumours arise from stroma?
Granulosa cell (can secrete oestrogens)
Theca cell/ Leydig cell (can secrete androgens)
Fibroma
What is Meig’s syndrome?
Fibroma
Ascites
Pleural effusion
Where do secondary ovarian tumours metastasise from?
From breast
Pancrease
Stomach
GI
Clinical presentation of ovarian cancer?
Mass/Swelling/ Pressure symptoms Transperitoneal spread - omental disease, maligant asictes with protein exudate Insidous symptoms Early satiety Change of bowel habit Weight loss DOB DVT Bloating
What genetic conditions are sometimes associated with ovarian cancer?
BRCA1 and 2
HNPCC (Lynch sydrome)
Risk factors for ovarian cancer?
Old
Nulliparity
Family history
How does the oral contraceptive pill influence risk for ovarian cancer?
Protective
Investigations for ovarian cancer?
Tumour markers - CA125 and CEA
USS and CT
In what conditions is CA125 raised?
Ovarian cancer Endometriosis Peritonitis/ infection Pregnancy Pancreatitis Ascites from another cause e.g. liver disease Other malignancies
What is the use for CA125 marker?
Follow up of ovarian cancer
Rather than diagnosis
In what conditions is CEA (carcino-embryonic antigen) raised?
Ovarian cancer - especially mucinous tumours
What is the main use for CEA marker?
Exclude mets from GI primary
What is the risk of malignancy index (RMI) for ovarian cancer?
Menopausal status x serum CA125 x ultrasound score
Treatment of ovarian mass?
Removal or drainage if benign
Malignant - remove ovarian and uterus and maybe omentum
Chemo
Is cure likely for ovarian carcinoma?
Unlikely unless just confined to ovary at presentation
