Pelvic Mass

Question 1

non-gynae causes of pelvic mass?

Answer 1

bowel
- constipation
- caecal carcinoma
- appendix abscess
- diverticular acscess
bladder/urological
- retention
- pelvic kidney (transplanted)
ascites (can be due to cirrhosis, heart failure etc)
other (e.g retroperitoneal tumour)

Question 2

important aspects of history for pelvic mass?

Answer 2

symptoms

past gynae and family history (lynch, BRCA, HLRCC genes)

Question 3

how can bi-manual examination be used to determine origin of mass?

Answer 3

if it is in line with cervix and/or moves when you move the cervix - most likely gynaecological/uterine
if its not in line/more lateral and doesnt move with cervix - most likely adnexal (non-gynae)

Question 4

what blood tests are done in pelvic mass?

Answer 4

FBC
LFTs
RFTs
CA125
LDH
AFP
HCG
(also do urine test)

Question 5

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Answer 5

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Question 6

when is shifting dullness exam useful?

Answer 6

minimal fluid (around 500ml)
can show ascites

Question 7

what examination can be used for higher fluid volumes?

Answer 7

fluid thrill

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Question 8

how is RMI calculated?

Answer 8

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Question 9

categories of RMI?

Answer 9

RMI <30 = 3 in 100 risk of ovarian cancer
RMI 30-200 = 20 in 100 risk
RMI >200 = 75 in 100

Question 10

why is CA125 affected in ovarian cancer?

Answer 10

CA125 produced by mesothelial cells which are found in ovaries (as well as other places however)

Question 11

further investigations in pelvic mass?

Answer 11

CT (good at birds eye view - looking for spread)
MRI (good for looking at specific organ)
hysteroscopy (only done if theres a bleeding problem to look in uterine cavity)
diagnostic laparoscopy (if scans cant find an abnormality)
pathology

Question 12

how is albumin often affected in gynae cancer?

Answer 12

usually low

- increased capillary permeability leads to protein loss and ascites etc

Question 13

benign pleural mass with pleural effusion and high CA125?

Answer 13

meig’s syndrome

- usually a right pleural effusion

Question 14

primary benign ovarian tumours?

Answer 14

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Question 15

what are functional cysts?

Answer 15

related to ovulation (follicular/luteal cysts)
rarely >5cm
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Question 16

features of endometriosis?

Answer 16

severe dysmenorrhoea
premenstrual pain
dyspareunia 
often associated with infertility
1/3 are asymptomatic
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Question 17

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Answer 17

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Question 18

features of dermoid cyst?

Answer 18

totipotential (can be any human tissue)

- teeth, hair, sebaceous material, thyroid tissue etc

Question 19

treatment options for benign mass?

Answer 19

conservative (mainly in functional cysts)
medical (i endometriosis) - GnRH analogues, OCP
surgical - laparoscopic/laparotomy
ovarian cystectomy
unilateral oophrectomy
bilateral oophrectomy
pelvic clearance

Question 20

how might a benign mass present acutely?

Answer 20

torsion
rupture
haemorrhage

Question 21

first line investigation in high CA125?

Answer 21

US scan

- might go straight to fast track clinic for a CT if very suspicious of malignancy

Question 22

what type of malignancy is most common in pre/post menopausal women?

Answer 22

pre = germ cell
post = serous

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Question 24

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Question 25

how does ovarian cancer present?

Answer 25

mass, swelling ……

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Question 26

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Question 27

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Question 28

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Question 29

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Question 30

when else might high CA125 be seen?

Answer 30

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Question 31

fertility sparing treatment can only be used in which type of ovarian cancer?

Answer 31

germ cell (unilateral salpingoophrectomy +/- chemotherapy)

Question 32

how are other cancers managed?

Answer 32

chemotherapy +/- surgery

except for stage 1A where surgery alone is enough

Question 33

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Question 34

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