Pelvic Mass Flashcards
Bowel causes of pelvic mass
Constipation
Caecal carcinoma
Appendix abscess
Diverticular abscess
Uterine causes of a pelvic mass
Pregnancy
Fibroids
Cancer?
What would the difference in surgery be if you thought it was benign/malignant ovarian mass?
Malignant–> Open Surgery (Laparotomy)
Benign–> Laproscopically
What are the 5 types of Fallopian tube pathology
- Inflammation
- Cysts/tumours
- Serous tubal intraepithelial carcinoma
- Endometriosis
- Ectopic pregnancy
What diagnosis should always be considered in any female of reproductive age with amenorrhoea + acute hypotension or an acute abdomen
Ectopic pregnancy
What are functional cysts related to
Ovulation
Are functional cysts something to worry about?
No. Rarely >5cm in diameter, usually resolve spontaneously, often incidental finding
What is an example of a follicular cyst?
Polycystic ovaries
How does endometrial cysts present?
Severe dysmetnnorhoea
Premenstural pain
Dyspareunia
Tender mass
What is the risk with large chocolate cysts?
It may rupture
What are the 4 types of cyst
Functional
Endometrial
Epithelial
Mesothelial
What is the appearance of endometriosis?
Shiny surface with lots of vascularity
What are the potential complications of endometriosis?
Pain Cyst formation Adhesions Ectopic pregnancy Malignancy (endometrial carcinoma)
Name 3 protective factors for ovarian tumours
OCP
Pregnancy
Breastfeeding
What 4 things increase the risk of ovarian tumours?
Genetics - BRACA -Lynch Syndrome (HNPCC) PCOS Endometriosis
What are the two tumour markers used in ovarian cancer?
CA125
CEA
How is the risk of malignancy (RMI) calculated
Menopausal status x serum CA125 x US score
3 modes of spread of ovarian cancer
- Transcoelomic spread/peritoneal seeding within pelvis
- Haematogenous spread
- Brain mets
What does optimal surgical resection mean?
<1cm left
What is suboptimal resection of ovarian tumour?
> 1cm left
TRUE/FASLE
Chemotherapy can be given pre/post surgery. Tend to be given first if the tumour is a higher stage
TRUE
1A or 1B- Chemo afterwards
IIIc or IV- Chemo first
Give an example of a platinum agent?
Carboplatin
When is hormonal therapy used?
Women with recurrent, platinum-resistant, ovarian cancer
OR
In those wishing to avoid/delay further chemotherapy
Why is BRACA phenotype good if you are diagnosed with ovarian cancer?
Repeated good response to platinum based chemotherapy
Longer remissions
Improved overall survival stage for stage
What is the most common type of ovarian tumour (90%)?
Epithelial ovarain tumour
What are the five types of epithelial ovarian tumour?
Serous Mucinous Endometriod Clear cell Brenner
What does endometriosis and clear cell carcinoma have an association with?
Lynch syndrome
TRUE/FALSE
Dermoid cysts are almost always benign in women and men
FALSE
- Almost always benign in women
- Almost always malignant in men
Germ cell tumours make up what percentage of ovarian tumours?
10% (some say up to 20%)
What is the most common type of germ cell tumour?
Mature benign cystic teratoma
“dermoid cyst”
What does a dermoid cyst look like on XR?
Rim calcification
Fat inside which is a different density
What is the most common malignant primitive germ cell tumour?
Dysgerminoma
Who is dysgerminoma most common in?
Almost exclusively children and young women (average age 22)
What are the three types of sex cord/stromal tumours?
Fibroma/Thecoma
Granulosa cell tumour
Sertoli-Leydig tumour
Granulosa cell tumours may be associated with what type of malformation?
Osteogenic
Metastatic tumours to the ovaries are classically from
Stomach
Colon
Breast
Pancreas
If Crookenburg tumour (Signet ring cancer cell) on the ovary is a metastasis from the …
breast
Malignant germ cell tumours may produce which hormone?
hCG or AFP
