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• Differential diagnosis of pelvic masses• Investigations and management• Benign ovarian cysts• Ovarian cancer
Pre-pubertal1. Functional cyst2. Germ cell tumour
Adolescent1. Functional cyst2. Pregnancy3. Dermoid4. Other germ cell tumour5. Obstructing
vaginal/uterine abnormality
6. Epithelial cell tumour
Reproductive1. Pregnancy2. Functional cyst3. Fibroids4. Epithelial tumour
Perimenopausal1. Fibroids2. Epithelial tumour3. Functional cyst
Diagnosis
• History and examination
• Ultrasound
• CT/MRI
• Tumour markers – CA125, CEA, CA19,9 hCg, alpha-fetoprotein
Management
Depends on symptoms and fertility issuesReassure that risk of malignancy tiny• Hysteroscopic removal (small submucosal)• Myomectomy• Embolisation• Hysterectomy
Management - Young women
• Small, simple, asymptomatic – leave alone and rescan 3 months later
• Complex – ovarian cystectomy or oopherectomy
• MDT involvement if any suspicious features
Management – older women
• Complex in older women – MDT involvement Further imaging Tumour markers TAH/BSO
• Simple, < 5cm, normal tumour markers – consider conservative management with repeat scan.
Fibroids
• Present in 25% of women
• More common: perimenopausal family history Afro-Caribbean women
• Sub-mucosal, subserosal, intramural
Ovarian Cancer• 5th, 6th and 7th decades
• Risk inversely correlated with parity.
• Genetic component – BRCA1 & BRCA2
• Presents late – usually with a mass or ascites
• No premalignant stage - screening
Epithelial Tumours
Serous• Most common• Bilateral in 50%• Cystic and solid components
Mucinous• Contain mucinous fluid• Pseudmyxoma peritonei
Sex Cord/Stromal TumoursGranulosa Cell• Secrete oestrogen – IMB or PMB
Fibroma• Usually unilateral• Meig’s Syndrome
Sertoli/Leydig Cell• Young women (20’s)• Secrete testosterone
Germ Cell TumoursDysgerminoma• Ages 10 – 30• May be raised hCG
Yolk sac tumour• Young women• Raised alphafetoprotein, normal hCG
Choriocarcinoma• Secrete hCG• Do not respond to chemotherapy
Teratoma• Usually benign -all 3 embryonic germ layers
Staging
Ia – One ovaryIb – Both ovariesIc – Ia/Ib with ruptured capsule, tumour on surface
of capsule, + ve washings or ascites
IIa – Extending to uterus and tubesIIb – Extending to other pelvic tissuesIIc - IIa/IIb with ruptured capsule, + ve washings or
ascites
IIIa – Pelvic tumour with microscopic peritonealspread
IIIb – Peritoneal spread < 2cmIIIc – Abdominal implants >2cm +/- positive
retroperitoneal or inguinal nodes
IV – Liver disease. Distant mets.