Pelvic Masses Flashcards
what investigations are done for pelvic masses?
tumour markers
USS pelvis
further imaging
RMI calculation
what two main tumour markers are measured when diagnosing a pelvic mass?
CA125
CEA
what is CA125?
a glycoprotein
when is CA125 elevated?
in ovarian cancer
what levels of tumour markers should make you suspect metastatic ovarian masses?
CA125/CEA <25
what other tumour markers should be measured in women under 40 when suspecting a pelvic mass?
AFP
HCG
LDH
when is AFP raised?
embryonal carcinoma
when is HCG raised?
choriocarcinoma
when is LDH raised?
dysgerminoma
what further imaging is done for a pelvic mass if someone is premenopausal?
MRI
what further imaging is done for a pelvic mass if someone is postmenopausal?
CT
what is the RMI?
risk of malignant index
what are the three components of the RMI?
menopausal status
ultrasonic features
serum CA125
what are the possible scores in the menopausal status part of the RMI?
premenopausal = 1 postmenopausal = 2
what ultrasonic features are looked at in the RMI?
multiloculated solid areas bilaterally ascites metastasis
what scores are given for ultrasonic features in the RMI?
none = 0 one = 1 >1 = 3
how is the risk of malignancy index calculated?
multiply scores together and then multiply by the serum CA125 level
what does the RMI indicate risk of?
ovarian cancer
what does an RMI <30 suggest?
low risk
3%
what does RMI 30-200 suggest?
medium risk
20%
what does an RMI >200 suggest?
high risk
75%
what are functional ovarian cysts related to?
ovulation
what size are functional ovarian cysts?
usually <5cm
how do functional ovarian cysts resolve?
usually by themselves
what can functional ovarian cysts cause?
menstrual disturbances
how can functional ovarian cysts cause acute abdomen?
may bleed or rupture
when do functional ovarian cysts need surgery?
acute abdomen
pain not settling with regular analgesia
what do dermoid cysts originate from?
totipotent cells
what can the contents of dermoid cysts be?
teeth
sebaceous material
hair
thyroid tissue
what needs to be considered when deciding on the management of benign ovarian tumours?
symptoms
fertility
menopausal status
how can most functional ovarian cysts be managed?
conservatively
what medical options are available for endometriosis?
GnRH analogues
oral contraceptives
aim = ovarian suppression
what are the surgical options for treatment of benign ovarian tumours?
ovarian cystectomy
unilateral/bilateral oophorectomy
pelvic clearance
how are borderline ovarian tumours managed in young women?
unilateral cystectomy/oophorectomy with close follow up
how are borderline ovarian tumours managed in postmenopausal women?
pelvic clearance
what is the lifetime risk of ovarian cancer?
2%
what symptoms suggest that investigations for ovarian cancer should be done?
persistent abdominal distention
early satiety/loss of appetite
pelvic/abdominal pain
increased urgency/frequency
what should be done if a woman >50 presents withs symptoms of IBS?
tests for ovarian cancer
what is the initial test for ovarian cancer?
CA125 measurement
what investigation should be done if CA125 is >35 IU/ml?
abdominal and pelvic USS
what is early disease in ovarian cancer?
disease remaining within the ovaries
what is advanced disease in ovarian cancer?
when the disease has spread beyond the pelvis
what are the three options for management of ovarian cancer?
surgery only
surgery with adjuvant chemotherapy
surgery with neoadjuvant chemotherapy
when can ovarian cancer be managed with surgery only?
stage 1A cancers
young women with germ cell tumours
when can ovarian cancer be managed with surgery and adjuvant chemo?
early stages
when can ovarian cancer be managed with neoadjuvant chemo and surgery?
advanced stages
what is the aim of surgery in ovarian cancer?
total macroscopic debunking of the tumour
