28 Aug Pelvic Mass

• Most common pelvic masses:
  • Ovarian cancer,
    • Most common gynecological cancer deaths in developed countries,
    • Primary from the ovarian stroma or metastatic,
    • Mean age at diagnosis is 63 years of age,
    • Lifetime prevalence 1.3 percent.
    • Risk factors:
      • Age:50-60 years,
      • Hereditary component: BRCA1 or BRCA2 gene: BRCA1 gene mutation have a 45 percent chance of developing epithelial ovarian cancer and those with the BRCA2 gene mutation have a 20 percent risk of getting ovarian cancer. Women with breast cancer are at an increased risk for ovarian cancer.
      • Lynch syndrome
      • Hormone replacement therapy
      • Nulliparity,
      • Smoking,
      • Fertility treatment, and
    • Signs and Symptoms:
      • Abdominal or pelvic mass,
      • Ascites,
      • Pleural effusion,
      • Abdominal bloating,
      • Weight loss,
      • Fatigue,
      • Indigestion,
      • Vaginal bleeding,
      • Constipation,
      • Bowel obstruction, and
      • Pressure on the rectum
    • Management:
      • Aggressive debulking procedure, and
      • Chemotherapy:
        • Carboplatin and
        • Paclitaxel
      • Prognosis:
        • The 5-year survival rates:
          • Stage I: 79-87 percent,
          • Stage II: 57-67 percent,
          • Stage III: 23-41 percent.
          • Stage IV:11 percent,
          • For all cases: 46 percent.
        • Uterine fibroids:
          • Not cancerous,
          • Common in childbearing age
          • Occur primarily during the childbearing years,
          • Originate in the inside of the uterine muscle, the middle part of the muscle or the external aspect of the muscle: form pedunculated masses palpated on a pelvic exam.
          • Risk factors:
            • Reproductive age group,
            • Vitamin D deficiency,
            • Family history,
            • Obesity,
            • Use of birth control pills,
            • Early menarche.
          • Signs and Symptoms:
            • Heavy menstrual bleeding
            • Long periods,
            • Very large external fibroids exert pressure on the bladder or rectum: symptoms of pelvic pain or increased frequency of urination, and
            • In rare cases, the size can grow so to outstrips its blood supply, causing acute pain from necrosis of the fibroid.
          • Management:
            • Hysteroscopic removal: Internal fibroid tumor,
            • Medical:
              • GnRH agonists (gonadotropin-releasing hormone agonists): stop menstruation and shrink the fibroid tumor size,
              • Progestin-secreting intrauterine device (IUD),
              • Tranexamic acid (which is only taken on days when the woman is actively bleeding), or
              • Birth control pills (which reduce bleeding but don’t shrink the size of the fibroids.
            • Surgical:
              • Myomectomy: remove the fibroids alone,
              • Total hysterectomy,
              • Ablation of the fibroid under MRI guidance, or
              • Uterine artery embolization
              • Laparoscopic fibroid removal (myomectomy)
            • Prognosis:
              • Excellent prognosis, especially when removed or treated medically,
              • Complications: anemia from excessive blood loss.
            • Mass effect from endometriosis,
            • Ectopic pregnancy.