Pelvic mass

Question 1

non gynae causes for pelvic mass bowel

Answer 1

constipation - commonest
caecal cancer
appendix abscess
diverticular abscess

Question 2

non gynae causes for pelvic mass other

Answer 2

urinary retention, pelvic kidney

retroperitoneal tumour
lymphomas

Question 3

gynae causes for pelvic mass

Answer 3

uterine
tubal and para tubal
ovarian

Question 4

uterine causes for pelvic mass

Answer 4

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

Question 5

what are uterine fibroids
age
size

Answer 5

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

Question 6

types of fibroids

Answer 6

submucosal
suserous
intracavity
intramural
pedunculated

Question 7

presentation of fibroids

Answer 7

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

Question 8

who are fibroids common in

Answer 8

afro carribean population

Question 9

investigations for suspected fibroids

Answer 9

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

Question 10

treatment of fibroids

Answer 10

hysterectomy - if family complete
myomectomy
uterine artery embolisation
hysteroscopic resection

Question 11

tubal swellings

Answer 11

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

Question 12

ovarian massess

Answer 12

tumours
functional cysts
endometriosis cysts

Question 13

what are functional cysts related to
size
rx
sx

Answer 13

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

Question 14

what can endometriosis cause
what is assoc with
px

Answer 14

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

Question 15

ovarian tumours that rise form the surface epithelium

Answer 15

serous
mucinous
endometrioid
clear cell
brenner

Question 16

ovarian tumours that arise from germ cells

Answer 16

benign cystic teratoma (dermoid cyst) - commonest

malignant germ cell tumours - v v v rare

Question 17

ovarian tumours arising from stroma

Answer 17

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

Question 18

what can malignant germ cells produce

Answer 18

HCG or AFP

Question 19

types of dermoid cyst

Answer 19

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

Question 20

granulosa cell tumours

Answer 20

oestrogen producing

precocious puberty, PMB

Question 21

thecal tumours

Answer 21

androgen producing

hirsutism -> virilisation

Question 22

fibromas

Answer 22

meigs syndrome with benign fibroma and pleural effusion and ascites

Question 23

secondary mets in ovary

Answer 23

breast
pancreas
stomach
GI primaries

Question 24

presentation of ovarian cancer

Answer 24

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

Question 25

referred ovarian cancer

Answer 25

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

Question 26

genetics and ovarian cancer

Answer 26

BRACA1/2 | lynch syndrome

Question 27

risk factors for ovarian cancer | what protects

Answer 27

age nulliparity FH OCP

Question 28

ix for ovarian cancer

Answer 28

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

Question 29

CA125 raised when | when more useful

Answer 29

``` in 80% of cancers endometriosis peritonitis/infection preg pancreatitis ascites other malignancies ``` for follow up rather than dx

Question 30

CEA raised when | primary function

Answer 30

moderately elevated in ovarian cancer esp in mucinous tumours exclude mets from GI primary

Question 31

USS finding of ovarian cancer

Answer 31

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

Question 32

what is RMI

Answer 32

menopausal status x CA125 x USS score

Question 33

treatment of ovarian cyst/mass

Answer 33

removal or drainage if benign | removal of ovaries and uterus

Question 34

acute presentation of pelvic mass

Answer 34

cyst - rupture, haemorrhage, torsion and ischaemia fibroid degeneration - red, compromised blood supply, seen in pregnancy or in peri menopause

Question 35

examination for pelvic mass

Answer 35

``` anaemia cachexia chest breast nodes legs abdo speculum/bimanual ```

Question 36

describing the mass

Answer 36

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

Question 37

ix of pelvic mass

Answer 37

``` 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 ```