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Flashcards in Pelvic mass Deck (37):
1

non gynae causes for pelvic mass bowel

constipation - commonest
caecal cancer
appendix abscess
diverticular abscess

2

non gynae causes for pelvic mass other

urinary retention, pelvic kidney

retroperitoneal tumour
lymphomas

3

gynae causes for pelvic mass

uterine
tubal and para tubal
ovarian

4

uterine causes for pelvic mass

pregnancy

fibroids - commonest

endometrial cancer - but usually presents early with PMB before mass

cervical cancer - late presentation with renal failure/bleeding/pain before mass is seen

5

what are uterine fibroids
age
size

very common
leiomyosarcomas very rare
>40s
can be few cm to bigger and multiple

6

types of fibroids

submucosal
suserous
intracavity
intramural
pedunculated

7

presentation of fibroids

may be asymp/incidental finding
menhorrhagia
pelvic mass
pain/tenderness but this if pregnant or menopause
pressure symptoms - increased frequency and nocturia

8

who are fibroids common in

afro carribean population

9

investigations for suspected fibroids

Hb if heavy bleeding
USS - usually dx
MRI for more precise localisation

10

treatment of fibroids

hysterectomy - if family complete
myomectomy
uterine artery embolisation
hysteroscopic resection

11

tubal swellings

ectopic preg - usually ruptures before becoming a pelvic mass

hydrosalpinx - fluid blocking tube - often longstanding/incidental

pyosalpinx - pus blocking tube - acute/inflam

paratubal cysts - usually small and incidental - embryological remnants

12

ovarian massess

tumours
functional cysts
endometriosis cysts

13

what are functional cysts related to
size
rx
sx

follicular cysts/luteal cysts

rarely >5cm dm

usually resolve spontaneously

often asymp/incidental finding
may be menstrual disturbance
may bleed or rupture and cause pain

14

what can endometriosis cause
what is assoc with
px

can cause blood filled cysts

severe dysmehnorrhagia, premenstrual pain, dyspareunia, sub fertility

tender mass with nodularity behind uterus

asympt till large choc cysts which may rupture

15

ovarian tumours that rise form the surface epithelium

serous
mucinous
endometrioid
clear cell
brenner

16

ovarian tumours that arise from germ cells

benign cystic teratoma (dermoid cyst) - commonest
malignant germ cell tumours - v v v rare

17

ovarian tumours arising from stroma

granulosa cells - secrete oestrogens - percasious puberty
theca/lydig cells severe androgens - androgenisation
fibroma - meigs syndrome

18

what can malignant germ cells produce

HCG or AFP

19

types of dermoid cyst

totipotential
teeth, sebaceous materia, hair
thyroid tissue -> thyrotoxicosis

20

granulosa cell tumours

oestrogen producing
precocious puberty, PMB

21

thecal tumours

androgen producing
hirsutism -> virilisation

22

fibromas

meigs syndrome with benign fibroma and pleural effusion and ascites

23

secondary mets in ovary

breast
pancreas
stomach
GI primaries

24

presentation of ovarian cancer

mass, swelling, pressure symptoms
early peritoneal spread - malignancy ascites with protein exudate
insidious symptoms
often referred

25

referred ovarian cancer

heart burn/indigestion
early satiety
weight loss/anorexia
bloating
pressure symptoms (esp bladder)
change of bowel habit
SOB/pleural effusion
leg oedema/DVT

26

genetics and ovarian cancer

BRACA1/2
lynch syndrome

27

risk factors for ovarian cancer
what protects

age
nulliparity
FH

OCP

28

ix for ovarian cancer

hx and exam
CA 125, CEA markers
US - nature
CT - assessing spread

29

CA125 raised when
when more useful

in 80% of cancers
endometriosis
peritonitis/infection
preg
pancreatitis
ascites
other malignancies

for follow up rather than dx

30

CEA raised when
primary function

moderately elevated in ovarian cancer esp in mucinous tumours

exclude mets from GI primary

31

USS finding of ovarian cancer

complex mass with solid and cystic areas
multi loculated
thick separations
associated ascites
bilateral disease

32

what is RMI

menopausal status x CA125 x USS score

33

treatment of ovarian cyst/mass

removal or drainage if benign
removal of ovaries and uterus

34

acute presentation of pelvic mass

cyst - rupture, haemorrhage, torsion and ischaemia

fibroid degeneration - red, compromised blood supply, seen in pregnancy or in peri menopause

35

examination for pelvic mass

anaemia
cachexia
chest
breast
nodes
legs
abdo
speculum/bimanual

36

describing the mass

size - cms or weeks gestation
consistency
surface
tenderness
mobility
relation to uterus
pouch of douglas

37

ix of pelvic mass

Hb
WCC/CRP if suspected inflam
Biochem esp serum albumin
tumour markers - CA125, CEA, HCG, AFP
CXR
USS
MRI for fibroids/uterine mass
CT - suspected ovarian cancer