Pelvic Mass Flashcards
what are the non-gynaecological causes of pelvic mass?
bowel = constipation, caecal carcinoma, appendix abscess, diverticular abscess
bladder / urological = urinary retention
other = retroperitoneal tumour, ascites
what are the gynaecological causes of pelvic mass?
pregnancy
uterine = benign and malignant
adnexal masses = benign and malignant
what is the framework that is useful when it comes to pelvic mass evaluation?
symptoms = slow/fast growing, pain, pressure symptoms, systemic symptoms, AUB, incidental
abdo exam = masses, tenderness, shifting dullness, fluid thrill, scars
bimanual/pelvic exam = masses, tenderness, shifting dullness, fluid thrill, cervical excitation, mass movement, adnexal tenderness
blood tests = FBC, LFTs, RFT, CA125, LDH, AFP, HCG
USS = transabdominal and TV to assess uterus and adnexae
what factors contribute to a patients risk of malignancy index (RMI)?
menopausal status (1 point if pre, 3 if post)
US features - multiloculated, solid ascites, mets (>1 feature = 3 points)
serum CA125 level
*multiply the 3 together for RMI
what does an RMI >200 indicate?
3 in 4 change of malignancy
what further investigations can be done if there is high suspicion of malignancy?
CT
MRI
hysteroscopy
diagnostic laparoscopy
what condition is characterised by benign ovarian fibroma associated with ascites +/- pleural effusion (usually on RHS not bilateral)?
Meig’s syndrome
*do not assume this is stage 4 ovarian cancer
what are the different types of benign ovarian cysts?
functional cysts = usually associated with ovulation and therefore resolve on their own
endometriomas = endometriosis causing chocolate cysts, assoc with dysmenorrhoea and dyspareunia
dermoid cyst (arise from germ cells)= totipotential eg teeth, hair and thyroid tissue
how can benign ovarian tumours be treated?
conservative
medical (only in endometriomas)
- GnRH analogues
- oral contraceptive pill
surgery - laparoscopic / laparotomy
- ovarian cystectomy (just remove cyst / lesion)
- unilateral oopherectomy (maintains fertility)
- bilateral oopherectomy
- pelvic clearance
how does malignant ovarian cancer usually spread into the peritoneum?
trans-coelomic
- deposits on multiple peritoneal surfaces
- omental disease / infiltration
- malignant ascites with protein exudate
other than mass, swelling and pressure symptoms, what are varied presentations of ovarian cancer?
heartburn / indigestion early satiety weight loss / anorexia bloating change of bowel habit SOB / pleural effusion leg oedema or generalised oedema DVT
what can raise CA125 levels apart from ovarian malignancy?
endometriosis peritonitis / infection pregnancy pancreatitis ascites
what is the treatment of germ cell ovarian tumours?
fertility sparing
unilateral salpingoopherectomy +/- chemotherapy
what is the treatment of other (inc epithelial) ovarian tumours?
chemotherapy + surgery
*except for stage 1A when only surgery is sufficient
what is the name of neoadjucant chemo?
given in an attempt to reduce the cancer so that surgical procedure will not need to be so extensive
