Pelvic Mass Flashcards
What are some differentials for a pelvic mass in a premenopausal woman?
Functional cyst, ovarian malignancy, ectopic pregnancy, hydrosalpinx, pregnancy, endometriosis, bladder malignancy
What are some differentials for a pelvic mass in a post menopausal woman?
benign ovarian tumour, ovarian malignancy, abscess, uterine fibroid, bladder/bowel cancer
What are key points to ask in a history of pelvic mass?
Past cancer Nulliparity Early menarche/late menopause No breastfeeding? COC (protective) HRT
Why is Ca125 an unreliable investigation?
It can be raised in pregnancy, endometriosis, fibroids, cirrhosis, not just ovarian cancer
What are you mentioning on pelvic exam when examining a mass?
Size, mobility, consistency, is it separate from the uterus?
What is the risk of malignancy index?
RMI= U x M x Ca125
U stands for ultrasound, patients get a point for cysts, ascites, bilateral ascites
M is for menopause 1 point for premenopausal and 3 points for postmenopausal
Ca125 level is measured in serum
If RMI score is higher than 250 an urgent gynae referral is needed
Why is it important to examine the breasts in a pelvic mass exam?
10% of ovarian malignancies are associated with BRCA1 and BRCA2
What are the common sites for ovarian cancer mets?
Lung-haemoptysis
Liver-jaundice
Peritoneum-distension
What are the CT stages of ovarian cancer?
Stage 1: in ovary (75% 5 year survival)
Stage 2: beyond ovaries but confined to pelvis (45% 5 year survival)
Stage 3: beyond pelvis but confined to abdomen (25% 5 year survival)
Stage 4: Disease is beyond the abdomen (5% 5 year survival)
How do we treat ovarian cancer?
Assess eligibility for surgery
Total hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy
Otherwise chemotherapy
How do we follow up ovarian cancer patients?
CA125 can determine relapse
CT scanning
Palliative care
