Pelvic Mass Flashcards
(59 cards)
1
Q
When is shifting dullness useful?
A
- with minimal fluid
500ml
2
Q
Situations when CA125 is elevated?
A
- endometriosis
- pleural effusion
- uterine fibroids
- ovarian cancer
- pancreatitis
- ASCITES of any cause; liver cirrhosis
- PID
- peritonitis
3
Q
When is CA125 produced?
A
- the mesothelial cell on the ovarian surface/ pleural surface/ peritoneum are stimulate
4
Q
What demographic gr. is predisposed to functional cysts?
A
- pre-menopausal women
5
Q
SYmptoms of endometriosis ?
A
- period-related GI symptoms (painful BOWEL movements)
- period-related urinary symptoms (BLOOD in urine)
- severe DYSMENORHEA
- PMENSTRUAL pain
- dyspareunia and pain AFTER sex
– infertility a.w with one of the above
6
Q
What is a dermoid cyst?
A
- d.t totipotent cells= can differentiate into any cells
can have thyrotocxicosis /teeth/
7
Q
How to manage ovarian benign tumors?
A
- do not treat unless there are symptoms
- how to preserve fertility
MEDICAL: GnRH analogues, OCP
SURGERY: laparotomy/ laparoscopic
cystecomty
oopherectomy —BCRCA (uni-/b.l)
pelvic clearance
8
Q
Symptoms of torsion?
Sign seen on transvaginal ultrasound with Doppler flow?
A
- 20-40 y.o pt with ACUTE abdomen and relevant hx
- SYNCOPAL attacks
- N.V
- lack of blood flow to the ovary
9
Q
First line management of raised CA125?
A
USS
10
Q
What are appendicile tumors a.w?
A
- ovarian tumors
11
Q
Recent stroke should be a deterrent for operations? True?
A
YES
- HIGH morbidity for post-op in those with RECENT CVA
12
Q
Teenager with LARGE ovarian mass? Likely to be _________
A
- germ cell tumors
teenager with LARGE malignant mass- REMOVE IT
13
Q
Common ovarian tumors in post-menopausal women?
A
- serosal tumors
High-grade
14
Q
How to manage ovarian cancer in young women?
A
- FERTILITY SPARING for young women (unilateral salpingoopherectomy +/- chemo)
15
Q
What is important in early disease?
A
- conduct a thorough explorative laporotomy (have a feel of the lnear by organs)
16
Q
What is borderline ovarian tumors?
A
- less aggressive
can spread
-less invasive (10-20 years)
17
Q
BOWEL causes of pelvic masses
A
- constipation
- caecal carcinoma
- appendix abscess
- diverticular abscess
18
Q
Urological causes of pelvic mass?
A
- urinary retention
- benign/ malignant growth in bladder
19
Q
What blood tests should be done for pelvic masses?
A
- FBC
- U&Es
- LFTs
- RFTs
- CA125
- LDH
- AFP
- HCG
20
Q
What is RMI?
A
- aka Risk of Malignancy Index
- score is given based on:
1. menopausal status
2. Ultrasound ovarian features
3. actual Ca125
21
Q
What does it mean to have an RMI of > 200 ?
A
- 3 out of 4 pts WILL have OC
22
Q
If RMI is between 30-200?
A
0.2% chance
23
Q
What FURTHER INVESTIGATIONS can be performed after an USS is done for a pelvic mass?
A
- CT
- MRI
- Hysteroscopy
- Diagnostic laparoscopy
24
Q
What does the CT scan pick up on?
A
- useful for retroperitoneal structures (LYMPH nodes)
- useful as a BIRD’S eye view of ALL organs in the pelvis and abdomen
25
When is the MRI used?
- for FINER details of SOFT tissue masses
| can identify components of cyst, endometrioma, PCOS, extent of cancer invasion
26
Name a germ cell tumor.
benign cystic teratoma
| dermoid cyst
27
Name benign ovarian tumors arising from the STROMA.
FIBROMA
| beware of MEIG's Syndrome
28
What cells are part of the stroma and how may that affect the hormones released?
- Granulosa cell= secretes Estrogen
| - Theca/ leydig cells= secrete androgens
29
Name primary benign ovarian tumors arising from the surface epithelium.
- serous
- mucinous
- endometroid
- brenner
- clear cell
30
What is Meig's Syndrome?
- involves a benign ovarian fibroma a.w ASCITES +/- pleural effusion
31
What is MEIG $ often confused with?
- a benign ovarian fibroma may be confused with stage 4 Ovarian Cancer
32
What is the prognosis of functional cysts?
- <5cm
- incidental finding
- resolves spontaneously
33
What are functional cysts a.w?
ovulation!
34
Name 2 functional cysts.
- follicular cysts
| - luteal cysts
35
What may functional cysts cause?
- menstrual dist
urbance
- may BLEED/ rupture and cause PAIN
36
How to manage functional cysts?
1. Watchful waiting
| 2. surgery (if potentially cancerous/large/persistent)
37
What are the signs of endometriotic cysts?
1. severe dysmenorrhea
2. premenstrual pain
3. Dyspareunia
- ---occasionally asymptomatic, until its a LARGE chocolate cyst and it ruptures
38
What are the clinical findings of the endometriotic cysts?
subfertility
- tender mass with NODULARITY and tenderness behind the uterus
- "boggy uterus"
39
What maybe seen in a dermoid cyst?
- teeth, sebacious material, hair, thyroid tissue
40
Which surgeries may be performed?
- ovarian cystectomy
- unilateral/B.L oopherectomy
- pelvic clearance
41
When may surgeries be performed?
- in acute presentation
| - --torsion/rupture/ Hemorrhage
42
Describe the ways in whcih ovarian cancer may present as.
- heartburn
- early SATIETY
- wgt LOSS
- BLOATING
- pressure symptoms (freq. and urgency)
- SOB/ pleural eff.
- leg edema (DVT)
43
Where ovarian Ca said to spread to?
- early transperitoneal spread
- deposits on MULTIPLE peritoneal surfaces
- ---OMENTAL infiltration
- ---> MALIGNANT ascites with protein exudates
44
How is one dx with ovarian cancer?
- non-gynaecologically
| - ---d.t insidious path
45
How to manage germ cell tumors?
- Fertility sparing, unilateral salpingoopherectomy +/- chemotherapy
46
What is the aim of surgery?
- total macroscopic DEBULKING of tumor
| v. impotant for prognosis
47
What is meant by staging via midline incisions in ovarian cancer?
----done through MIDLINE incisions (allows palpation of ALL peritoneal surface)
48
What is the AIM of staging via midline incision?
- to exclude disease involving the LIVER, spleen, peritoneum, retroperitoneal nodes, appendix, diaphragm
49
Define cytoreduction.
- to remove AS many cancerous cells as possible
| - --optimal cytoreduction: when there is no VISIBLE disease left behind
50
What is given PRIOR to the sugrical procedure?
- NEOADJUVANT chemotherapy (to shrink the cancer)
51
What is supraradical surgery for ovarian cancer?
- removal of supracolic omentum, peritoneal ablation, removal of the SPLEEN +/- large/ small bowel resection
52
Name sources IIary ovarian tumors.
- BREAST, STOMACH, PANCREAS, GI primaries
53
What is a kruckenbrug tumor?
- metastasis from the STOMACH
| - ----characteristic SIGNET ring on histology
54
What are borderline ovarian tumors?
- less aggressive
- can spread transcoelomic
- ----risk of recurrence (5-10% in the long run)
55
Most common symptom of fibroids?
- Abnormal Uterine Bleeding
| - ---presents with PRESSURE symptoms
56
Which group of people are leiomyomas seen in?
- ladies >40y.o
| - --very COMMON
57
What pressure symptoms may be seen with Fibroids?
- dyspareunia
- pelvic pain
- constipation
- urinary symptoms
58
What surgical rx can be done for fibroids?
- laproscopic/ laparotomy
- myomectomy
- subtotal hysterectomy
- total hysterectomy
59
What medical interventions for fibroids?
- GnRh analogues
- Mirena
- Progestins
