Pelvic Mass Flashcards

1
Q

What are the potential non-gynaecological causes of a pelvic mass?

A

GI:

  • Constipation!
  • Caecal carcinoma
  • Appendix/Diverticular abscess

Bladder/Urological:
- Urinary retention

Other
Retroperitoneal tumour
Ascitis due to liver disease

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2
Q

What are the gynaecological causes of a pelvic mass?

A
  • PREGNANCY

UTERINE
Benign or Malignant mass

ADNEXAL MASSES
Benign or Malignant mass

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3
Q

How should a pelvic mass be assessed?

A
  • Symptoms
  • Abdominal examination
  • Bimanual/pelvic examination
  • Blood Tests
  • USS (Transabdominal and transvaginal)
  • Check past Gynae Hx and FHx (Lynch, BRCA, HLRCC*)
  • URINE TEST (pregnancy/ectopic)
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4
Q

What symptoms and features should be asked about if suspecting a pelvic mass?

A

Slow/fast growing mass?
pain?
pressure symptoms - frequency, urgency etc
systemic symptoms?

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5
Q

What signs should you look for on examination of the abdomen?

A

Masses
tenderness
shifting dullness/fluid thrill (ascites)
scars

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6
Q

What signs should you look for on bimanual palpation of the pelvis?

A

cervical excitation
mass movement
adnexal tenderness

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7
Q

What other tumour markers should be tested alongside CA125?

A

AFP, BetaHCG

check for non-epithelial ovarian cancers

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8
Q

What factors contribute to a patients Risk of Malignancy Index (RMI)?

A

Menopausal Status (1 point if Pre, 3 if Post)

US Features - multiloculated, solid, ascitis, mets
>1 feature = 3 points

Serum CA125 level

(Multiply 3 together for RMI)

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9
Q

What does an RMI >200 indicate?

A

3 in 4 chance of malignancy

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10
Q

What further investigations can be done if there is a high suspicion of malignancy?

A

CT
MRI
Hysteroscopy
Diagnostic laparoscopy

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11
Q

What condition is characterised by a benign ovarian fibroma associated with ascites +/- pleural effusion (usually on RHS not bilateral)?

A

Meig’s syndrome

do not assume this is stage 4 ovarian cancer

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12
Q

Functional cysts are usually associated with ovulation and therefore resolve on their own. TRUE/FALSE?

A

TRUE

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13
Q

How can benign ovarian tumours be treated?

A
  • Conservative
  • Medical – (only in endometriomas)
    => GnRH analogues, Oral Contraceptive Pill
  • Surgical – Laparoscopic/ Laparotomy
    OVARIAN CYSTECTOMY (just remove cyst/lesion)
    UNILATERAL OOPHERECTOMY (maintains fertility)
    BILATERAL OOPHERECTOMY
    PELVIC CLEARANCE
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14
Q

How does ovarian cancer usually spread into the peritoneum?

A
  • trans-coelomic
  • Deposits on multiple peritoneal surfaces
  • Omental disease/infiltration
  • Malignant ascites with protein exudate
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15
Q

What can raise CA125 levels apart from ovarian malignancy?

A
  • Endometriosis
  • Peritonitis/infection
  • pregnancy
  • Pancreatitis
  • Ascites
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16
Q

What is the aim of surgery in ovarian tumours?

A

Total macroscopic debulking

Complete cytoreduction offers best improvement in survival.

17
Q

Describe the principles of ovarian surgery in early disease.

A
  • midline incision to allow palpation of peritoneal surface
  • Assessment of peritoneal cytology, hysterectomy, removal of ovaries and fallopian tubes
  • infracolic omentectomy should be performed.
  • Capsular rupture should be avoided.
18
Q

What is meant by ‘Supraradical’ surgery for ovarian cancer?

A
  • removal of supracolic omentum
  • peritoneal stripping or ablation
  • removal of the spleen
    +/- small or large bowel resection

=> carries high mortality/morbidity
=> only offer to suitable women

19
Q

What are the treatment options for fibroids?

A

Conservative

Medical – GnRH analogues, Mirena, Progestins

Surgical – Laparoscopic/Laparotomy

  • Myomectomy (Hysteroscopic or abdominal)
  • Subtotal Hysterectomy
  • Total hysterectomy