Best Practice Case Studies-Adnexal Masses

Pdf Summary

The document discusses the evaluation and management of adnexal masses, which can arise from both gynecologic (like ovarian cancer) and non-gynecologic causes (such as bowel abscesses). In women presenting with symptoms such as persistent abdominal or pelvic pain, increased abdominal size, and rapid satiety, evaluation for ovarian cancer is critical, despite the low sensitivity of pelvic examinations for detecting adnexal masses. For women of reproductive age, ectopic pregnancy should be ruled out.<br /><br />The recommended first step in imaging for an adnexal mass is transvaginal ultrasonography, which can help differentiate between benign and malignant masses based on characteristics like size, complexity, and septation. CA 125 tests, although helpful, are not specific to ovarian cancer and vary between pre- and postmenopausal women. As such, CA 125 should not be solely relied upon to distinguish benign from malignant masses.<br /><br />Regarding management, it is advised to conduct serial ultrasonographies and CA 125 tests for monitoring. Persistent masses larger than 6 cm or those lasting over 12 weeks should be referred to specialists. Factors such as age, family history, and genetic predispositions (like BRCA mutations) contribute to ovarian cancer risk. The document also emphasizes that screening for ovarian cancer is generally not recommended for the asymptomatic population due to inefficacy.<br /><br />The report highlights the importance of rapid diagnosis and differential evaluation, noting that symptoms such as bloating and urinary problems commonly signal more severe conditions. Management guidelines differ for special populations, such as premenarchal patients and pregnant women, with referrals necessary in cases of suspected malignancy. As early detection significantly improves survival rates for early-stage ovarian cancer, vigilant assessment and imaging are crucial.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, CASE 39

Topic OB/GYN

Keywords

2nd Edition, CASE 39

2nd Edition

OB/GYN

adnexal masses

ovarian cancer

transvaginal ultrasonography

CA 125 test

ectopic pregnancy

BRCA mutations

gynecologic causes

non-gynecologic causes

differential evaluation

early detection