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Y3 Reproduction > Pelvic Masses > Flashcards

Pelvic Masses Flashcards

1
Q

what investigations are done for pelvic masses?

A

tumour markers
USS pelvis
further imaging
RMI calculation

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2
Q

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

A

CA125

CEA

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3
Q

what is CA125?

A

a glycoprotein

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4
Q

when is CA125 elevated?

A

in ovarian cancer

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5
Q

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

A

CA125/CEA <25

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6
Q

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

A

AFP
HCG
LDH

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7
Q

when is AFP raised?

A

embryonal carcinoma

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8
Q

when is HCG raised?

A

choriocarcinoma

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9
Q

when is LDH raised?

A

dysgerminoma

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10
Q

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

A

MRI

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11
Q

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

A

CT

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12
Q

what is the RMI?

A

risk of malignant index

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13
Q

what are the three components of the RMI?

A

menopausal status
ultrasonic features
serum CA125

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14
Q

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

A 
premenopausal = 1
postmenopausal = 2
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15
Q

what ultrasonic features are looked at in the RMI?

A 
multiloculated 
solid areas 
bilaterally 
ascites 
metastasis
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16
Q

what scores are given for ultrasonic features in the RMI?

A 
none = 0 
one = 1 
>1 = 3
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17
Q

how is the risk of malignancy index calculated?

A

multiply scores together and then multiply by the serum CA125 level

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18
Q

what does the RMI indicate risk of?

A

ovarian cancer

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19
Q

what does an RMI <30 suggest?

A

low risk

3%

20
Q

what does RMI 30-200 suggest?

A

medium risk

20%

21
Q

what does an RMI >200 suggest?

A

high risk

75%

22
Q

what are functional ovarian cysts related to?

A

ovulation

23
Q

what size are functional ovarian cysts?

A

usually <5cm

24
Q

how do functional ovarian cysts resolve?

A

usually by themselves

25
Q

what can functional ovarian cysts cause?

A

menstrual disturbances

26
Q

how can functional ovarian cysts cause acute abdomen?

A

may bleed or rupture

27
Q

when do functional ovarian cysts need surgery?

A

acute abdomen

pain not settling with regular analgesia

28
Q

what do dermoid cysts originate from?

A

totipotent cells

29
Q

what can the contents of dermoid cysts be?

A

teeth
sebaceous material
hair
thyroid tissue

30
Q

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

A

symptoms
fertility
menopausal status

31
Q

how can most functional ovarian cysts be managed?

A

conservatively

32
Q

what medical options are available for endometriosis?

A

GnRH analogues
oral contraceptives

aim = ovarian suppression

33
Q

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

A

ovarian cystectomy
unilateral/bilateral oophorectomy
pelvic clearance

34
Q

how are borderline ovarian tumours managed in young women?

A

unilateral cystectomy/oophorectomy with close follow up

35
Q

how are borderline ovarian tumours managed in postmenopausal women?

A

pelvic clearance

36
Q

what is the lifetime risk of ovarian cancer?

A

2%

37
Q

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

A

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

38
Q

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

A

tests for ovarian cancer

39
Q

what is the initial test for ovarian cancer?

A

CA125 measurement

40
Q

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

A

abdominal and pelvic USS

41
Q

what is early disease in ovarian cancer?

A

disease remaining within the ovaries

42
Q

what is advanced disease in ovarian cancer?

A

when the disease has spread beyond the pelvis

43
Q

what are the three options for management of ovarian cancer?

A

surgery only
surgery with adjuvant chemotherapy
surgery with neoadjuvant chemotherapy

44
Q

when can ovarian cancer be managed with surgery only?

A

stage 1A cancers

young women with germ cell tumours

45
Q

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

A

early stages

46
Q

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

A

advanced stages

47
Q

what is the aim of surgery in ovarian cancer?

A

total macroscopic debunking of the tumour

Y3 Reproduction (49 decks)

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