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Management of Suspected Ovarian Masses in Premenopausal Women RCOG, 2011 Aboubakr Elnashar

Management of Suspected Ovarian Masses in Premenopausal Women RCOG, 2011 Aboubakr Elnashar Benha University, Egypt. CONTENTS Introduction Types of adnexal masses How to minimise patient morbidity Assessment Treatment. 1. Introduction Premenopausal ovarian masses

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Management of Suspected Ovarian Masses in Premenopausal Women RCOG, 2011 Aboubakr Elnashar

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  1. Management of Suspected OvarianMasses in Premenopausal Women RCOG, 2011 AboubakrElnashar Benha University, Egypt ABOUBAKR ELNASHAR

  2. CONTENTS • Introduction • Types of adnexal masses • How to minimise patient morbidity • Assessment • Treatment ABOUBAKR ELNASHAR

  3. 1. Introduction • Premenopausal ovarian masses • Benign: almost all • Malignant: • <50y: 1:1000 • >50y: 3:1000 . • Preoperative differentiation: • Between the benign and the malignant: • problematic. • Exceptions: germ cell tumours • elevations of α-FP and hCG. • 10% of suspected ovarian masses: • non-ovarian in origin ABOUBAKR ELNASHAR

  4. 2. Types of adnexal masses Benign ovarian Functional cysts Endometriomas Serous cystadenoma Mucinouscystadenoma Mature teratoma Ovarian cyst: fluid-containing structure ≥30 mm in diameter 4% of women ABOUBAKR ELNASHAR

  5. Benign non-ovarian Paratubal cyst Hydrosalpinges Tubo-ovarian abscess Peritoneal pseudocysts Appendiceal abscess Diverticular abscess Pelvic kidney ABOUBAKR ELNASHAR

  6. Secondary malignant ovarian Predominantly: breast and gastrointestinal carcinoma. ABOUBAKR ELNASHAR

  7. Primary malignant ovarian Germ cell tumour Epithelial carcinoma Sex-cord tumour Secondary malignant ovarian Predominantly breast and gastrointestinal carcinoma. ABOUBAKR ELNASHAR

  8. 3. How to minimisepatient morbidity Conservative management Functional or simple ovarian cysts: thin-walled cysts No internal structures ≤50 mm maximum diameter: usually resolve over 2–3 menstrual cycles without the need for intervention. ABOUBAKR ELNASHAR

  9. II. Use of laparoscopic techniques where appropriate cost-effective {earlier discharge from hospital}. ABOUBAKR ELNASHAR

  10. III. Referral to a gynaecological oncologist where appropriate. {Mean survival time for women is significantly improved}: early diagnosis and referral is important. Indications 1. Histological diagnosis 2. strong suspicion of Borderline ovarian tumours 20% of borderline ovarian tumours appear as simple cysts on US ABOUBAKR ELNASHAR

  11. 4. Preoperative assessment of women with ovarian masses • History • Examination • Blood tests • Imaging • Estimation the risk of malignancy ABOUBAKR ELNASHAR

  12. I. History • Risk factors • Protective factors for ovarian malignancy • Family history of ovarian or breast cancer. • Symptoms suggestive of • endometriosis • ovarian malignancy: • persistent abdominal distension • appetite change including increased satiety • pelvic or abdominal pain • increased urinary urgency and/or frequency. ABOUBAKR ELNASHAR

  13. II. Physical examination • Poor sensitivity in the detection of ovarian masses (15–51%) • Essential • abdominal and vaginal • Evaluation of mass: • tenderness, mobility, nodularity and ascites. • local lymphadenopathy. • Acute pain: complications should be considered (torsion, rupture, hge). ABOUBAKR ELNASHAR

  14. III. Blood tests • Serum CA-125 • Marker for epithelial ovarian carcinoma • raised in 50% of early stage disease. • Not indicated: simple ovarian cyst • unreliable in ddbenign from malignant in premenopausal women • {increased rate of false positives and reduced specificity}. ABOUBAKR ELNASHAR

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