Pelvic masses Flashcards
Go over this pic of the main structures of the pelvis
What are some of the non-gynaecological causes of pelvic masses ?
Bowel:
- Constipation!
- Caecal carcinoma - colon cancer at the caecum area
- Appendix abscess
- Diverticular abscess
Bladder/Urological.
- Urinary retention
- (pelvic kidney)
Other:
e.g. retroperitoneal tumour.
What are some of the gynaecological origins of pelvic masses ?
- Uterine - body, cervix
- Uterine Tubes
- Ovarian
What are the uterine causes of pelvic masses ?
- Pregnancy!
- Uterine fibroids.
- Endometrial cancer
- Cervical cancer
What is the commonest cause of uterine pelvic masses ?
Uterine fibroids (remember that uterine fibroids are very common)
Endometrial and cervical cancers are common causes of pelvic masses - T or F?
False
- Endometrial cancer usually presents with postmenopausal bleeding and therefore is picked up then so unusual to be at the stage where it is large enough to produce a mass
- Cervical cancer - this would also be a late presentation of cervical cancer so unlikely as usually picked up in screening or vaginal bleeding etc would have resulted in it being picked up
What are uterine fibroids ?
They are benign smooth muscle tumours of the uterus also known as leiomyomas
Who do uterine fibroids typically occur in ?
Women >40
How big can uterine fibroids become ?
Usually few cm, but may be much bigger & multiple - A very large uterine fibroid can cause the uterus to expand to the size of a 6 or 7 month pregnancy
Pic shows large uterine fibroids
What are the typical presenting features of uterine fibroids ?
Many are asymptomatic
Others may have the following symptoms:
- Menorrhagia - they often produce heavy and prolonged periods (dont generally cause intermenstrual or postmenopausal bleeding)
- Pelvic mass
- Pain/tenderness
- Pelvic Pressure
- Urinary and bowel symptoms - freq urination, difficulty emptying bladder, constipation
- May cause fertility problems
What is red degeneration of fibroid ?
It is a rare complication where thrombosis of fibroid vessels occurs followed by venous engorgement an inflammation, causing severe abdo pain +/- vomiting and low grade fever, and localised peritoneal tenderness usually occuring in the last half of pregnancy or 6 months following childbirth (puerperium)
What is the typical presentation of a uterine fibroid felt on pelvic exammination?
- A firm, enlarged, and irregularly shaped non-tender uterus is characteristic of uterine fibroids.
- The mass can be moved slightly from side-to-side.
How are uterine fibroids diagnosed ?
- 1st line = Transvaginal ultrasound - showing a smooth echogenic (lighter colour) mass which is often multiple
- 2nd line = hysteroscopy
Firboid in pic is indicated
What is the pharmacological treatment symptoms of uterine fibroids in terms of:
- Red degeneration
- Menorrhagia + fibroid < 3cm
Red degernation requires painkiller and usually settles down
Menorrhagia:
- 1st line = mierena IUS
- 2nd line = tranexamic acid (not mefenamic acid as shown to be ineffective) think good for pain
- 3rd line = Combined pill or other homronals (progestogens also shown to be ineffective)
Need to try at least 2 medical ones before surgery
What is the treatment required for most people with uterine fibroids ?
None - usually asymptomatic
