Uterine fibroids, Adnexal masses

Question 1

What is a type 0 fibroid?

Answer 1

pedunculated intracavitary fibroid

Question 2

What is a type 1 fibroid?

Answer 2

<50% intramural

Question 3

What is a type 2 fibroid?

Answer 3

> 50% intramural

Question 4

What is a type 3 fibroid?

Answer 4

100% intramural but contacts endometrium

Question 5

What is a type 4 fibroid?

Answer 5

Intramural

Question 6

What is a type 5 fibroid?

Answer 6

Subserosal fibroid with >50% intramural component

Question 7

What is a type 6 fibroid?

Answer 7

Subserosal fibroid with < 50% intramural component

Question 8

What is a type 7 fibroid?

Answer 8

Pedunculated subserosal fibroid

Question 9

What are the different ways to treat uterine fibroids?

Answer 9

1. Expectant managment
2. Medical management
3. Surgical management

Question 10

Who are candidates for expectant management for uterine fibroids?

Answer 10

Asymptomatic
No desire for treatment

Question 11

Who are candidates for medical management for uterine fibroids?

Answer 11

Symptomatic and no desire for surgical management

Question 12

Which medications primarily address bleeding symptoms of uterine fibroids?

Answer 12

1. Tranexamic acid
2. GnRh antagonist ( elagolix)
3. Levongestrel IUD
4. Hormonal contraceptives
5. NSAIDs
6. Subdermal implant

Question 13

Which medications can address the bulk symptoms of uterine fibroids?

Answer 13

1. GnRh agonist (Lupron)

Question 14

What are the surgical options for uterine fibroid management?

Answer 14

1. Uterine artery embolization
2. Ultrasound focused energy
3. Endometrial ablation
4. Myomectomy
5. Hysterectomy

Question 15

What women are uterine artery embolization not indicated in?

Answer 15

1. Women desiring future fertility
2. Postmenopausal women
3. Contraindication to contrast use
4. Asymptomatic uterine fibroids

Question 16

What is a disadvantage to uterine artery embolization?

Answer 16

Reduction in ovarian function

Question 17

What are the potential complications of uterine artery embolization?

Answer 17

1. Symptomatic degeneration/pain
2. Myometrial infarction/necrosis
3. Myometritis
4. Bacteremia
5. Uterine perforation/intraperitoneal injury
6. Hemorrhage
7. Loss of ovarian function

Question 18

What is the most important independent risk factor for ovarian cancer?

Answer 18

Age

Question 19

Which adnexal masses can be managed expectantly?

Answer 19

1. Simple cyst up to 10cm
2. Endometrioma
3. Hydrosalphinx
4. Mature cystic teratoma

Question 20

What is the lifetime risk of ovarian cancer in the general population?

Answer 20

1%

Question 21

What is the lifetime risk of ovarian cancer when you have a family member with ovarian cancer?

Answer 21

5%

Question 22

What is the risk of ovarian cancer with BRCA 1 mutation?

Answer 22

40% by age 70

Question 23

What is the risk of ovarian cancer with BRCA 2 mutation?

Answer 23

20% by age 70

Question 24

What is the risk of ovarian cancer with Lynch syndrome?

Answer 24

5-10%

Question 25

What features on ultrasound gives an increased risk of malignancy?

Answer 25

1. Septations 2. Increased color doppler 3. Size>10cm 4. Solid components 5. irregularity 6. Free fluid 7. Mural nodules 8. papillary excrescences

Question 26

What things can cause elevated Ca-125?

Answer 26

Cancer PID Endometriomas Pregnancy Inflammatory conditions NOn gyn malignancies

Question 27

What is an abnormal Ca 125 test for menopausal women?

Answer 27

>35

Question 28

When is surgery indicated for adnexal mass?

Answer 28

Symptoms Suspicion for malignancy

Question 29

IF you have a menopausal woman with a TOA what is the recommendation and why?

Answer 29

Recommendation is for surgery due to risk of malignancy

Question 30

What are tumor markers for adnexal mass?

Answer 30

CA125 CEA CA19-9 HE4

Question 31

What are the imaging options for adnexal masses?

Answer 31

Ultrasound preferred Can you MRI

Question 32

When do you refer to gyn oncology?

Answer 32

Premenopausal= Very elevated CA125, ascites, metastases Postmenopausal= elevated CA125, ascites, nodular or fixed mass, abdominal metastases

Question 33

What patients are candidates for surgical management of adnexal mass?

Answer 33

1. High risk mass on imaging (O-RAD 5 or signs of metastases) 2. Postmenopausal patient + adnexal mass + elevated tumor marker 3. Postmenopausal + large adnexal 4. Postmenopausal + ORAD 4 + signs or symptoms of ovarian cancer 1. Premenopausal + O-RAD 4 mass + very elevated CA125 2. Premenopausal + suspected germ cell or sex chord stromal tumor

Question 34

Management of physiologic cyst on imaging measuring <5cm?

Answer 34

No follow up

Question 35

Management of physiologic cyst on imaging measuring >5cm?

Answer 35

Surveillance

Question 36

Management of asymptomatic endometrioma measuring <5cm?

Answer 36

Surveillance

Question 37

How to treat recurrent physiologic ovarian cyst?

Answer 37

Oral combined hormonal birth control

Question 38

Management of hydrosalphinx?

Answer 38

Asymptomatic does not require management or surveillance Symptomatic requires evaluation to rule out other causes then removal

Question 39

Management of paratubal or paraovarian cyst?

Answer 39

Treat if symptomatic, concern for torsion or >10cm

Question 40

Recommended surveillance for low risk adnexal mass O-RAD 3?

Answer 40

3 months then 6 months

Question 41

Recommended surveillance for intermediate risk adnexal mass O-RAD 4?

Answer 41

Premenopausal= 6 weeks then every 3-6 months for 1 year Postmenopausal= 6 weeks, 12 weeks then every 3-6 months for 1 year