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Reproductive & Sexual Health > Pelvic Mass > Flashcards

Pelvic Mass Flashcards

1
Q

What are the non gynaecological causes of pelvic masses?

A

Bowel

  • constipation
  • caecal carcinoma
  • Appendix abscess
  • Diverticular abscess

Bladder/urological

  • urinary retention

Other

  • retropertoneal tumour
  • Ascites
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2
Q

What are the gynaecological causes of pelvic mass?

A
  • Pregnancy
  • uterine: benign and malignant
  • adnexal masses: benign and malignant
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3
Q

Describe a useful framework for pelvic mass evaulation?

A
  • Symptoms
  • Abdominal examination
  • Bimanual/examination
  • blood tests
  • USS (transabdominal and transvaginal)
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4
Q

What symptoms need to be enquired about in evaluation of pelvic mass

A

Slow/fast growing , pain, pressure symptoms, AUB, incidental

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5
Q

What should be looked for in abdominal examination for pelvic mass?

A

Masses, tenderness, shifting dullness, fluid thrill, scars

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6
Q

What should be looked for in bimanual palpation in pelvic mass evaulation?

A

Masses, tenderness, shifting dullness, fluid thrill, scars, cervical excitation, mass movement, adnexal tenderness

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7
Q

What tests should be done in pelvic mass examination?

A

Blood tests

  • FBC, LFT, RFT, CA125, LDH, AFP, HCG

Urine Test

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8
Q

What should be assessed in USS for pelvic mass?

A

Assess uterus, adnexae

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9
Q

What is RMI?

A

Risk of malignancy index

If RMI >2– then 3/4 patients will have oc

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10
Q

What is RMI index scored on?

A
  • Menopausal status
    • Premenopausal = 1
    • Postmenopausal = 3
  • Ultrasonic features, No feature = 0, 1 feature = 1, >1 feature= 3
    • Multiloculates
    • Solid areas
    • Bilaterally
    • Ascites
    • Metastasis
  • ​Serum Ca125
    *
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11
Q

What are the further investigations of Pelvic Mass?

A

Computerised tomography

MRI

Hysteroscopy

Diagnostic laparoscopy

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12
Q

What are primary benign ovarian tumours?

A

Functional cysts arising from;

surface epithelium, germ cells or stroma

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13
Q

What types of benign ovarian tumours arise from surface epithelium?

A
  • Serous
  • Mucinous
  • Endometroid
  • Brenner
  • Clear cell
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14
Q

What types of benign ovarian tumours arise from germ cells?

A

Benign cystic teratoma (= dermoid cyst, common)

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15
Q

What do benign ovarian tumours arising from stroma secrete?

A

If granulosa may secrete oestrogens

If theca/leydic gells may secrete androgens

Also Fibroma (beware Meig’s syndrome)

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16
Q

What is Meig’s syndrome?

A

Benign ovarian fibroma associated with ascites +/- pleural effusion therefore do not assume this is stage 4 cancer

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17
Q

What kinds of functional cysts are there?

A

Follicular cysts

Luteal cysts

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18
Q

What is the treatment for functional cysts?

A

Usually resolve spontaenously

Expectant management appropriate

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19
Q

How may functional cysts present?

A

Asymptomatic/incidental finding

May be menstrual disturbance

May bleed or rupture and cause pain

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20
Q

What does endometriosis cause?

A

Endometriomas, chocolate cysts

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21
Q

What is endometriosis associated with?

A

Severe dysmenorrhoea, premenstrual pain, dyspareunia, subfertility

22
Q

How do endometriotic cysts typically prsent?

A

Tender mass with ‘nodularity’ and tenderness behind uterus.

Ocassionally aysmptomatic untill large chocolate cyst, which may rupture

23
Q

What is a dermoid cyst?

A

A cyst with totipotential

Teeth, sebaceous material, hair, thyroid tissue > thyrotoxicosis

24
Q

Describe the x-ray appearance of a dermoid cyst?

A

Rim calcification

Fat inside= different density

Calcification= tooth?

25
Q

What are the treatment options of benign overian tumours?

A
  • conservative
  • medical- only in endometriomas (GnRH analogues, OCP)
  • Surgical - laparoscopic/laparotomy
    • Ovarian cystectomy
    • unilateral oophorectomy
    • bilateral oophorectomy
    • pelvic clearance
26
Q

What are the primary malignant ovarian tumours arising from surface epithelium?

A
  • Serous
  • Mucinous
  • Endometrioid
  • Brenner
  • Clear cell
27
Q

What are the primary malignant ovarian tumours arising from germ cells?

A
  • malignant cystic teratoma
  • dysgerminoma
28
Q

What are the primary malignant ovarian tumours arising from stroma?

A
  • If granulosa cell may secrete oestrogens
  • If theca/leydigcell may secrete androgens.
  • Also fibroma (beware Meig’s syndrome)
29
Q

How does ovarian cancer present?

A

Mass, swelling, pressure symptoms

30
Q

How does ovarian cancer spread?

A

Early transperitoneal spread (trans-coelomic)

  • deposits on mulitple peritoneal surfaces
    • omental disease/infiltration*
    • malignant ascites with protein exudate*
31
Q

What is the varied presentation of ovarian cancer?

A
  • heartburn/indigestion
  • early satiety
  • weight loss/anorexia
  • bloating
  • pressure symptoms (esp bladder)
  • change of bowel habit
  • SOB/pleural effusion
  • Leg oedema or DVT
  • generalised oedema if low albumin
32
Q

Ca125 is raised in __% of ovarian cancers, only __% of stage 1 disease

A

Ca125 is raised in 80% of ovarian cancers, only 50% of stage 1 disease

33
Q

When is moderate elevation of CA125 seen?

A
  • Endometriosis
  • Peritonitis/infection
  • Pregnancy
  • Pancreatitis
  • Ascites from any cause e.g. liver disease
  • Other malignancies gynae/non gynae
34
Q

What are the treatment options of malignant ovarian cancer?

A
  • Germ cell tumours
    • fertility sparing, unilateral salpingoopherectomy +/- chemotherapy
  • other cancers (MC, serous, epithelial)
    • chemotherapy + surgery; except for stage 1A when only surgery is sufficient
35
Q

What is the aim of the surgery in ovarian cancer?

A

Total macroscopic debulking of tumour

36
Q

What is cytoreduction?

A

Reduction of cells

Cytoreductive surgery is to remove as many cancerous cells as possible

37
Q

What is optimal cytoreduction?

A

Optimal cytoreduction is where no visible disease is left behing following the laparotomy

38
Q

What is ‘early disease’?

A

Disease remaining within the ovaries

39
Q

Describe staging in early disease surgery

A

Through a midline incision to allow palpation of all peritoneal tissue.

  • assessment of peritoneal cytology, hysterectomy, removal of ovaries and fallopian tubes and infracolic omentectomy should be performed
  • Aim to exclude disease involving the liver, spleen, peritoneum, retroperitoneal nodes, appendix and diaphragm by close clinical inspection and palpation.
40
Q

What should be avoided in early disease surgery?

A

Capsular rupture

41
Q

What is involved in surgery for advanced disease?

A

Surgery and chemotherapy

42
Q

What is ‘advanced disease’?

A

When the disease has spread beyond the pelvic

FIGO staging III and IV

43
Q

What are the two ideas when considering surgery for advanced disease?

A
  1. aggressive surgical cytoreduction with the aim of leaving no residual disease
  2. cytoreduction where residual deposits are no more than 1cm in diameter
44
Q

When is chemotherapy and neoadjuvant treatment given?

A

Chemotherapy is given prior to the surgical procedure. Neoadjuvant chemotherapy may be given in an attempt to shrink the cancer so that the surgical procedure may not need to be so extensive.

45
Q

What is the commonest site of metastatic disease?

A

Ovary

46
Q

What are the common primaries of metastatic ovarian cancer?

A

Breast, pancreas, stomach and GI

47
Q

What is a kruckenberg tumour?

A

Characteristic signet ring histology (usually metastatic from stomach)

48
Q

What are uterine fibroids?

A

Leiomyomas- benign smooth muscle tumours

(Leiomyosarcomas very rare)

49
Q

What is the common presentation of uterine fibroids?

A

AUB

Can present with pressure symptoms

50
Q

What are the different types of uterine fibroids?

A
  • pedunculated
  • intravacitary
  • subseroids
  • submucous
  • intramural
51
Q

What are the treatment options for uterine fibroids?

A
  • conservative
  • medical
    • GnRH analogues, mirena, progestins
  • surgical
    • laparoscopic/laparotomy
    • myomectomy (hysteroscopic or abdominal)
    • subtotal hysterectomy
    • total hysterectomy

Reproductive & Sexual Health (54 decks)

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