Uterine fibroids, Adnexal masses Flashcards
What is a type 0 fibroid?
pedunculated intracavitary fibroid
What is a type 1 fibroid?
<50% intramural
What is a type 2 fibroid?
> 50% intramural
What is a type 3 fibroid?
100% intramural but contacts endometrium
What is a type 4 fibroid?
Intramural
What is a type 5 fibroid?
Subserosal fibroid with >50% intramural component
What is a type 6 fibroid?
Subserosal fibroid with < 50% intramural component
What is a type 7 fibroid?
Pedunculated subserosal fibroid
What are the different ways to treat uterine fibroids?
- Expectant managment
- Medical management
- Surgical management
Who are candidates for expectant management for uterine fibroids?
Asymptomatic
No desire for treatment
Who are candidates for medical management for uterine fibroids?
Symptomatic and no desire for surgical management
Which medications primarily address bleeding symptoms of uterine fibroids?
- Tranexamic acid
- GnRh antagonist ( elagolix)
- Levongestrel IUD
- Hormonal contraceptives
- NSAIDs
- Subdermal implant
Which medications can address the bulk symptoms of uterine fibroids?
- GnRh agonist (Lupron)
What are the surgical options for uterine fibroid management?
- Uterine artery embolization
- Ultrasound focused energy
- Endometrial ablation
- Myomectomy
- Hysterectomy
What women are uterine artery embolization not indicated in?
- Women desiring future fertility
- Postmenopausal women
- Contraindication to contrast use
- Asymptomatic uterine fibroids
What is a disadvantage to uterine artery embolization?
Reduction in ovarian function
What are the potential complications of uterine artery embolization?
- Symptomatic degeneration/pain
- Myometrial infarction/necrosis
- Myometritis
- Bacteremia
- Uterine perforation/intraperitoneal injury
- Hemorrhage
- Loss of ovarian function
What is the most important independent risk factor for ovarian cancer?
Age
Which adnexal masses can be managed expectantly?
- Simple cyst up to 10cm
- Endometrioma
- Hydrosalphinx
- Mature cystic teratoma
What is the lifetime risk of ovarian cancer in the general population?
1%
What is the lifetime risk of ovarian cancer when you have a family member with ovarian cancer?
5%
What is the risk of ovarian cancer with BRCA 1 mutation?
40% by age 70
What is the risk of ovarian cancer with BRCA 2 mutation?
20% by age 70
What is the risk of ovarian cancer with Lynch syndrome?
5-10%
What features on ultrasound gives an increased risk of malignancy?
- Septations
- Increased color doppler
- Size>10cm
- Solid components
- irregularity
- Free fluid
- Mural nodules
- papillary excrescences
What things can cause elevated Ca-125?
Cancer
PID
Endometriomas
Pregnancy
Inflammatory conditions
NOn gyn malignancies
What is an abnormal Ca 125 test for menopausal women?
> 35
When is surgery indicated for adnexal mass?
Symptoms
Suspicion for malignancy
IF you have a menopausal woman with a TOA what is the recommendation and why?
Recommendation is for surgery due to risk of malignancy
What are tumor markers for adnexal mass?
CA125
CEA
CA19-9
HE4
What are the imaging options for adnexal masses?
Ultrasound preferred
Can you MRI
When do you refer to gyn oncology?
Premenopausal= Very elevated CA125, ascites, metastases
Postmenopausal= elevated CA125, ascites, nodular or fixed mass, abdominal metastases
What patients are candidates for surgical management of adnexal mass?
- High risk mass on imaging (O-RAD 5 or signs of metastases)
- Postmenopausal patient + adnexal mass + elevated tumor marker
- Postmenopausal + large adnexal
- Postmenopausal + ORAD 4 + signs or symptoms of ovarian cancer
- Premenopausal + O-RAD 4 mass + very elevated CA125
- Premenopausal + suspected germ cell or sex chord stromal tumor
Management of physiologic cyst on imaging measuring <5cm?
No follow up
Management of physiologic cyst on imaging measuring >5cm?
Surveillance
Management of asymptomatic endometrioma measuring <5cm?
Surveillance
How to treat recurrent physiologic ovarian cyst?
Oral combined hormonal birth control
Management of hydrosalphinx?
Asymptomatic does not require management or surveillance
Symptomatic requires evaluation to rule out other causes then removal
Management of paratubal or paraovarian cyst?
Treat if symptomatic, concern for torsion or >10cm
Recommended surveillance for low risk adnexal mass O-RAD 3?
3 months then 6 months
Recommended surveillance for intermediate risk adnexal mass O-RAD 4?
Premenopausal= 6 weeks then every 3-6 months for 1 year
Postmenopausal= 6 weeks, 12 weeks then every 3-6 months for 1 year
