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3 Reproduction > Pelvic Mass > Flashcards

Pelvic Mass Flashcards

1
Q

what are some non-gynaecological causes of a pelvic mass

A

Constipation
Caecal carcinoma
Appendic abscess
Diverticular abscess

urinary retention
pelvic kidney

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2
Q

where can gynaecological pelvic masses come from

A

Uterus - body, cervix
Tubal (and para tubal)
Ovary

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3
Q

what are the causes of uterine pelvic mass

A

Fibroids
Pregnancy
Endometrial cancer (however usually presents early so pelvic mass unlikely)
Cervical cancer

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4
Q

what are uterine fibroids

A

Leiomyomas (benign smooth muscle tumours)

v common esp >40 years

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5
Q

what are the different types of fibroids

A 
pedunculate - protrudes outside the muscle 
intracavitary - inside the uterus 
intramural - middle of muscle wall
submucous -bulge into cavity 
subserous - under the serosa
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6
Q

how do uterine fibroids present

A 
asymptomatic/incidental finding 
menorrhagia (V heavy periods) 
pelvic mass 
pain/tenderness
'pressure' symptoms
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7
Q

how do you investigate fibroids

A

Hb if heavy bleeding
US usually diagnostic
MRI for more precise localisation

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8
Q

how do you treat fibroids

A

expectant (leave it alone)
traditional hysterectomy if family complete

myomectomy
uterine artery embolisation
hysteropoc resection

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9
Q

what are causes of tubal swellings

A

Ectopic pregnancy
Hydrosalpinx (tube filled with fluid)
Pyosalpinx (tube filled with puss)
Paratubal cysts

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10
Q

causes of ovarian masses

A

tumours/neoplasm
-benign or malignant

non-tumours

  • functional cysts
  • endometriotic cysts (endometriosis on the ovary)
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11
Q

what is a functional cyst

A

cyst related to ovulation

  • follicular cysts
  • luteal cysts

usually resolve spontaneously
asymptomatic/incidental finding (my be mistral disturbance, bleeding, rupture and pain)

expectant management appropriate

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12
Q

what is an endometriotic cyst

A

endometriosis (endometrium in wrong place) causes endometrial deposits on the ovary

can cause blood filled cysts on ovaries (chocolate cysts)

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13
Q

how do endometriosic cysts present

A

severe dysmenorrhoea and premenstrual pain
dyspareunia (painful sex)
subfertility
tender mass with ‘nodularity’ and tenderness behind uterus
occasionally asymptomatic until large chocolate cyst which ruptures

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14
Q

where can primary ovarian tumours arise from

A

Surface epithelium
Germ Cells
Stroma

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15
Q

what primary ovarian tumours arise from the surface epithelium

A 
serous 
mucinous 
endometrioid 
clear cell 
Brenner
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16
Q

what primary ovarian tumours arise from germ cells

A

benign cystic teratoma (dermoid cyst)

malignant germ cell tumours (v rare)

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17
Q

what primary ovarian tumours arise from stroma

A

fibroma
if theca/leydig cell it secretes androgens
if granuloma cell it secretes oestrogen

18
Q

what do malignant germ cell tumours produce

A

HCG causing false positive pregnancy test of AFP

19
Q

what do dermoid cysts produce

A

totipotential

produce teeth, sebaceous material, hair

thyroid tissue - thyrotoxicosis

20
Q

what do granuloma cell tumours produce

A

oestrogen

leads to precocious puberty, post menopausal bleeding

21
Q

what syndrome are fibromas related to

A

Meig’s syndrome - benign fibroma with pleural effusion and ascites

22
Q

where do secondary (metastatic). ovarian tumours most commonly come from

A

breast
pancreas
stomach
GI primaries

23
Q

how does ovarian cancer usually present

A

mass, swelling or pressure symptoms

early transperitoneal spread - deposits on all peritoneal surfaces

malignant ascites with protein exudate

more insidious symptoms

bloating 
heart burn 
weight loss 
'pressure' symptoms eg. bladder change of bowel habit 
SOB/pleural effusion 
leg oedema or DVT
24
Q

what genes can predispose to ovarian cancer

A

BRACA 1 & 2 (breast and ovarian)

HNPCC (Lynch syndrome- bowel, endometrial, ovarian and others)

25
Q

what are some risk factors for ovarian cancer

A

increasing age
nulliparity
family history

(OCP is a protective factor)

26
Q

how do you investigate a suspected ovarian cancer

A

history and exam

tumour markers

USS - better for imagineer nature of cyst

CT - good for assessing disease outwit ovarian

27
Q

what tumour markers are measured in ovarian cancer

A

CA 125

Carcino-embryonic antigen (CEA )

28
Q

when is CA125 raised

A

in 80% of ovarian cancers

normal level does not exclude cancer

29
Q

what things can cause a moderate raise in CA125

A 
endometriosis 
peritonitis/infection 
pregnancy 
pancreatitis 
ascites 
other malignancies
30
Q

when is CEA (carcinoma-embryonic antigen) raised

A

moderately raised in ovarian cancer

especially in mucinous tumours

31
Q

what is the main function of CEA tumour marker

A

excluded mets from GI tumour

32
Q

how does ovarian cancer present on ultrasound scan

A

complex mass with solid cystic area

multi-lobulated

thick separations

associated ascites

bilateral disease

33
Q

how do you calculate the risk of malignancy index for ovarian cancer and what do you do if its high

A

combine menopausal status with serum CA125 and US score

if elevated refer to gynaecological cancer team

34
Q

how do you treat benign ovarian cysts

A

removal or drainage if benign

35
Q

how do you treat malignant ovarian cysts

A

delbuluking surgery (removal of ovaries and uterus with removal/biopsy of momentum)

examination of all peritoneal surfaces

chemotherapy given pre-srugery

unlikely to cure

36
Q

what symptoms to ask in a pelvic mass history

A 
slow/fast growing 
pain 
pressure symptoms 
menstrual history 
bloating
parity and fertility problems 
family history 
previous gynae history 
ovarian cancer symptoms
37
Q

how do you describe a pelvic mass

A 
size (cms or weeks gestation) 
consistency (soft, firm, craggy) 
surface (smooth, irregular) 
tenderness 
mobility 
relation to uterus 
pouch of Douglas
38
Q

what investigations are done for a pelvic mass

A 
Hb
WCC/CRP
Biochem esp serum albumin 
Tumour markers (CA125, CEA) 
USS
MRI for fibroids/uterine mass
CT for suspected ovarian Ca
CT/US guided tissue biopsy
39
Q

treatment option of endometriomas (endometrial cyst on ovary)

A

GnRH analogues
Oral contraceptive pill

if not surgery

40
Q

what is Meig’s syndrome

A

Benign ovarian fibroma associated with ascites +/- pleural effusion

41
Q

Treatment for germ cell tumours

A

fertility sparing treatment

unilateral salpingoophrectomy +/- chemotherapy

42
Q

treatment options for endometrial fibroids

A

conservative
medical
-GnRH analogues, mirena coil, progestins

surgical
-lapparoscopic myomectomy, subtotal hysterectomy or total hystorectomy

3 Reproduction (49 decks)

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