Pelvic Mass

Question 1

Clinical presentation of uterine fibroids?

Answer 1

Asymptomatic
Menorrhagia
Pelvic pain
Pain/tenderness - only disproportionate if red degeneration
Pressure symptoms

Question 2

What is red degeneration (carneous degeneration) of fibroid?

Answer 2

Haemorrhage in centre of fibroid causing disproportionate pain and tenderness

Question 3

Who gets uterine fibroids?

Answer 3

Afro-carribean

Over 40 years

Question 4

Investigation for fibroids?

Answer 4

FBC - Hb levels

Ultrasound - diagnostic

Question 5

Treatment of fibroid?

Answer 5

Asymptomatic - expectant
Hysterectomy
Myomectomy
Uterine artery embolisation 
Hysteroscopic resection

Question 6

What are some conditions (4) that cause tubal swellings?

Answer 6

Ectopic pregnancy
Hydrosalpinx
Pyosalpinx - acute/ inflammatory
Paratubal cysts - embryological remnant

Question 7

What are functional cysts?

Answer 7

Related to ovulation - follicular/ luteal cysts

Question 8

Clinical features of endometriosis?

Answer 8

Severe dysmenhorrhea
Premenstrual pain
Dysparenuia
Subfertility
Endometriomas - can rupture

Question 9

Which primary ovarian tumours arise from surface epithelium?

Answer 9

Serous
Mucinous
Endometrioid
Clear cell
Brenner

Question 10

Which primary ovarian tumours arise from germ cells?

Answer 10

Benign cystic teratoma AKA dermoid cyst

Malignant germ cell tumours - rare

Question 11

Which primary ovarian tumours arise from stroma?

Answer 11

Granulosa cell (can secrete oestrogens)
Theca cell/ Leydig cell (can secrete androgens)
Fibroma

Question 12

What is Meig’s syndrome?

Answer 12

Fibroma
Ascites
Pleural effusion

Question 13

Where do secondary ovarian tumours metastasise from?

Answer 13

From breast
Pancrease
Stomach
GI

Question 14

Clinical presentation of ovarian cancer?

Answer 14

Mass/Swelling/ Pressure symptoms
Transperitoneal spread - omental disease, maligant asictes with protein exudate
Insidous symptoms
Early satiety
Change of bowel habit
Weight loss
DOB
DVT
Bloating

Question 15

What genetic conditions are sometimes associated with ovarian cancer?

Answer 15

BRCA1 and 2

HNPCC (Lynch sydrome)

Question 16

Risk factors for ovarian cancer?

Answer 16

Old
Nulliparity
Family history

Question 17

How does the oral contraceptive pill influence risk for ovarian cancer?

Answer 17

Protective

Question 18

Investigations for ovarian cancer?

Answer 18

Tumour markers - CA125 and CEA

USS and CT

Question 19

In what conditions is CA125 raised?

Answer 19

Ovarian cancer
Endometriosis
Peritonitis/ infection
Pregnancy
Pancreatitis
Ascites from another cause e.g. liver disease
Other malignancies

Question 20

What is the use for CA125 marker?

Answer 20

Follow up of ovarian cancer

Rather than diagnosis

Question 21

In what conditions is CEA (carcino-embryonic antigen) raised?

Answer 21

Ovarian cancer - especially mucinous tumours

Question 22

What is the main use for CEA marker?

Answer 22

Exclude mets from GI primary

Question 23

What is the risk of malignancy index (RMI) for ovarian cancer?

Answer 23

Menopausal status x serum CA125 x ultrasound score

Question 24

Treatment of ovarian mass?

Answer 24

Removal or drainage if benign
Malignant - remove ovarian and uterus and maybe omentum
Chemo

Question 25

Is cure likely for ovarian carcinoma?

Answer 25

Unlikely unless just confined to ovary at presentation