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Repro and Sexual Health > Pelvic Mass > Flashcards

Pelvic Mass Flashcards

1
Q

What are common uterine masses?

A

Pregnancy
Fibroids
Endometrial cancer (presents early with PMB)
Cervical cancer

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2
Q

What is a fibroid?

A

Leiomyoma

Usually a few cm but can be much bigger and multiple

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3
Q

What are the different forms of fibroids?

A 
Pedunculated
Intramural 
Submucosal
Subserosal
Intracavitary
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4
Q

What is the presentation of a uterine fibroid?

A 
Asymptomatic or incidental finding 
Menorrhagia
Pelvic mass
Pain/ tenderness 
Pressure symptoms
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5
Q

When is the pain/ tenderness of uterine fibroids disproportionate?

A

Red degeneration in pregnancy or menopause

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6
Q

What investigation should be performed for suspected fibroids?

A

Hb if heavy bleeding
USS usually diagnostic (smooth echogenic mass often multiple)
MRI for more precise localisation

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7
Q

What is the treatment for fibroids?

A 
Expectant if asymptomatic
Myomectomy
Uterine artery embolisation 
Hysteroscopic resection 
Hysterectomy if family complete
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8
Q

What are the different causes of tubal swellings?

A 
Ectopic pregnancy (emergency, adnexal mass on USS) 
Hydrosalpinx (longstanding) 
Pyosalpinx (acute/ inflammatory) 
Paratubal cyst (small and incidental)
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9
Q

What are the causes of an ovarian mass?

A

Tumours/ neoplastic; benign or malignant

Not tumours; functional cysts, endometriotic cysts

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10
Q

What are the two types of functional cysts?

A

Follicular cysts

Luteal cysts

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11
Q

What size are functional cysts?

A

<5cm in diameter

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12
Q

Will functional cysts resolve spontaneously?

A

Yes; often asymptomatic/ incidental finding

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13
Q

What symptoms can functional cysts present with?

A

Menstrual disturbance

Can bleed/ rupture and cause pain

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14
Q

What is endometriosis?

A

Endometrial glands and stroma in the wrong place

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15
Q

What will endometriotic cysts look like?

A

Endometriomas

Chocolate cysts

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16
Q

What is endometriosis associated with?

A

Severe dysmenorrhoea
Pre-menstrual pain
Dyspareunia
Subfertility

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17
Q

Where are endometriotic cysts typically found?

A

Tender mass with nodularity behind uterus

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18
Q

What are the primary ovarian tumours that arise from the surface epithelium?

A 
Serous
Mucinous
Endometrioid
Clear cell
Brenner
19
Q

What are the primary ovarian tumours that arise from the germ cells?

A

Benign cystic teratoma

Malignant germ cell tumour

20
Q

What are the primary ovarian tumours that arise from the stroma?

A

Granulosa cell may secrete oestrogen
Theca/ leydig cell may secrete androgens
Fibroma = meig’s syndrome

21
Q

How can malignant germ cell tumours present?

A

hCG (false positive IPT) or AFP

22
Q

How can dermoid cysts present?

A

Totipotential
Teeth, sebaceous material, hair
Thyroid tissue -> thyrotoxicosis

23
Q

How can granulosa cell tumours present?

A

Oestrogens

Precocious puberty or PMB

24
Q

How can thecal tumours present?

A

Androgens
Hirsutism
Virilisation

25
Q

How can meig’s syndrome present?

A

Fibroma
Ascites
Right sided pleural effusion

26
Q

Is the ovary a common site for metastatic spread of disease?

A

Yes

27
Q

What primary tumours will commonly spread to the ovaries?

A

Breast
Pancreas
Stomach
GI

28
Q

How will ovarian cancer present?

A 
Mass
Swelling
Pressure 
Early satiety
Wt loss 
Bloating 
Change of bowel habit 
SOB/ pleural effusion 
Leg oedema/ DVT
Early transperitoneal spread; deposits on all peritoneal surfaces, omental disease, malignant ascites with protein exudate 
Insidious symptoms
29
Q

What genetic syndromes are assoc with ovarian cancer?

A 
BRCA 1 and 2 (breast and ovarian) 
Lynch syndrome (colorectal, endometrial, ovarian)
30
Q

What are risk factors for ovarian cancer?

A

Increasing age
Nulliparity
Family history
OCP is PROTECTIVE

31
Q

What are the ix for suspected ovarian ca?

A

History and exam
Tumour markers; ca-125 and CEA
Imaging; USS, CT (omental and peritoneal disease, lymph nodes)

32
Q

What can cause moderate elevation of Ca-125?

A 
Endometriosis
Peritonitis/ infection 
Pregnancy 
Pancreatitis
Ascites from other causes
Other malignancies gynae/ non gynae
33
Q

What is the main function of doing CEA in ovarian cancer?

A

Exclude mets from GI primary

Raised esp in mucinous tumours

34
Q

What are suspicious USS findings for ovarian cancer?

A 
Complex mass with solid and cystic area
Multi-loculated
Thick septations
Assoc ascites
Bilateral disease
35
Q

How is the RMI calculated?

A

Menopausal status x serum ca 125 x USS score

36
Q

How is an ovarian cyst treated?

A

Removal or drainage if likely benign

37
Q

What is the surgical treatment of an ovarian tumour?

A

Midline laparotomy to allow thorough assessment of the abdomen and pelvis; a total abdominal hysterectomy, bilateral salpingo-oophorectomy and infracolic omentectomy; biopsies of any peritoneal deposits; random biopsies of the pelvic and abdominal peritoneum; and retroperitoneal lymph node assessment

38
Q

When is chemo given in ovarian cancer?

A

Can be neo adjuvant or adjuvant

Platinum based

39
Q

What history is important to take in a pelvic mass presentation?

A 
Speed of onset/ duration of symptoms
Mass/ swelling/ bloating
Pressure symptoms (bladder or bowel) 
Pain (with periods, between, post coital)
Menstrual hx (heaviness, cycle) 
Cervical smear history
Parity and fertility problems 
Family history
Previous gynae problem
40
Q

What are the acute presentations of a pelvic mass?

A

Cyst accident; rupture, haemorrhage, torsion

Fibroid degeneration; red, compromised blood supply

41
Q

How is ascites examined for?

A

Shifting dullness

Fluid thrill

42
Q

How should the pelvic mass be described?

A 
Size; cm or weeks gestation 
Consistency; soft, firm, hard, craggy, indurated, boggy, fluctuant
Surface; smooth, irregular
Tenderness
Mobility
Relation to uterus
Pouch of douglas
43
Q

When is an MRI indicated in work up of a pelvic mass?

A

Fibroids or uterine mass

44
Q

When is a CT indicated in the work up for a pelvic mass?

A

Suspected ovarian ca

Repro and Sexual Health (77 decks)

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