Pelvic Masses

Question 1

what investigations are done for pelvic masses?

Answer 1

tumour markers
USS pelvis
further imaging
RMI calculation

Question 2

what two main tumour markers are measured when diagnosing a pelvic mass?

Answer 2

CA125

CEA

Question 3

what is CA125?

Answer 3

a glycoprotein

Question 4

when is CA125 elevated?

Answer 4

in ovarian cancer

Question 5

what levels of tumour markers should make you suspect metastatic ovarian masses?

Answer 5

CA125/CEA <25

Question 6

what other tumour markers should be measured in women under 40 when suspecting a pelvic mass?

Answer 6

AFP
HCG
LDH

Question 7

when is AFP raised?

Answer 7

embryonal carcinoma

Question 8

when is HCG raised?

Answer 8

choriocarcinoma

Question 9

when is LDH raised?

Answer 9

dysgerminoma

Question 10

what further imaging is done for a pelvic mass if someone is premenopausal?

Answer 10

MRI

Question 11

what further imaging is done for a pelvic mass if someone is postmenopausal?

Answer 11

CT

Question 12

what is the RMI?

Answer 12

risk of malignant index

Question 13

what are the three components of the RMI?

Answer 13

menopausal status
ultrasonic features
serum CA125

Question 14

what are the possible scores in the menopausal status part of the RMI?

Answer 14

premenopausal = 1
postmenopausal = 2

Question 15

what ultrasonic features are looked at in the RMI?

Answer 15

multiloculated 
solid areas 
bilaterally 
ascites 
metastasis

Question 16

what scores are given for ultrasonic features in the RMI?

Answer 16

none = 0 
one = 1 
>1 = 3

Question 17

how is the risk of malignancy index calculated?

Answer 17

multiply scores together and then multiply by the serum CA125 level

Question 18

what does the RMI indicate risk of?

Answer 18

ovarian cancer

Question 19

what does an RMI <30 suggest?

Answer 19

low risk

3%

Question 20

what does RMI 30-200 suggest?

Answer 20

medium risk

20%

Question 21

what does an RMI >200 suggest?

Answer 21

high risk

75%

Question 22

what are functional ovarian cysts related to?

Answer 22

ovulation

Question 23

what size are functional ovarian cysts?

Answer 23

usually <5cm

Question 24

how do functional ovarian cysts resolve?

Answer 24

usually by themselves

Question 25

what can functional ovarian cysts cause?

Answer 25

menstrual disturbances

Question 26

how can functional ovarian cysts cause acute abdomen?

Answer 26

may bleed or rupture

Question 27

when do functional ovarian cysts need surgery?

Answer 27

acute abdomen | pain not settling with regular analgesia

Question 28

what do dermoid cysts originate from?

Answer 28

totipotent cells

Question 29

what can the contents of dermoid cysts be?

Answer 29

teeth sebaceous material hair thyroid tissue

Question 30

what needs to be considered when deciding on the management of benign ovarian tumours?

Answer 30

symptoms fertility menopausal status

Question 31

how can most functional ovarian cysts be managed?

Answer 31

conservatively

Question 32

what medical options are available for endometriosis?

Answer 32

GnRH analogues oral contraceptives aim = ovarian suppression

Question 33

what are the surgical options for treatment of benign ovarian tumours?

Answer 33

ovarian cystectomy unilateral/bilateral oophorectomy pelvic clearance

Question 34

how are borderline ovarian tumours managed in young women?

Answer 34

unilateral cystectomy/oophorectomy with close follow up

Question 35

how are borderline ovarian tumours managed in postmenopausal women?

Answer 35

pelvic clearance

Question 36

what is the lifetime risk of ovarian cancer?

Answer 36

2%

Question 37

what symptoms suggest that investigations for ovarian cancer should be done?

Answer 37

persistent abdominal distention early satiety/loss of appetite pelvic/abdominal pain increased urgency/frequency

Question 38

what should be done if a woman >50 presents withs symptoms of IBS?

Answer 38

tests for ovarian cancer

Question 39

what is the initial test for ovarian cancer?

Answer 39

CA125 measurement

Question 40

what investigation should be done if CA125 is >35 IU/ml?

Answer 40

abdominal and pelvic USS

Question 41

what is early disease in ovarian cancer?

Answer 41

disease remaining within the ovaries

Question 42

what is advanced disease in ovarian cancer?

Answer 42

when the disease has spread beyond the pelvis

Question 43

what are the three options for management of ovarian cancer?

Answer 43

surgery only surgery with adjuvant chemotherapy surgery with neoadjuvant chemotherapy

Question 44

when can ovarian cancer be managed with surgery only?

Answer 44

stage 1A cancers | young women with germ cell tumours

Question 45

when can ovarian cancer be managed with surgery and adjuvant chemo?

Answer 45

early stages

Question 46

when can ovarian cancer be managed with neoadjuvant chemo and surgery?

Answer 46

advanced stages

Question 47

what is the aim of surgery in ovarian cancer?

Answer 47

total macroscopic debunking of the tumour