Page 1 of 1: gyne -ovarian mass

manpreet108 · Credits: 30682 My Scrapbook

4x4 cm ovarian mass in a post menopausal women .m/t is -
1.wait and watch .
2.surgical exploration
3prog pills
4clomiphene therapy.

pls rep with reasons.

pratik · Credits: 11374 My Scrapbook

the question framed is of very broad terms. thus considering to be the common condition which is simple ovarian cyst.

then any mass less then 5 cm u should go for wait and watch with serial usg evaluation.

guest · Credits: 79189 My Scrapbook My Reading List 262569 Books

There have been different ultrasound scoring systems to try to predict malignancy. Anytime the ultrasonographer sees the following characteristics, there may be an increased chance of malignancy beyond just a simple cyst:

Giving a score of one for any of the above findings, the risk of malignancy cases were divided into :
Risk of Malignancy by Ultrasound Findings
Ultrasound score-------Benign--------Malignant
--------------------------(n=290)-------(n=75)
0-------------------------79 (27%)------3 (4%)
1-------------------------12 (39%)------13 (17%)
2-5-----------------------99 (34%)------59 (79%)
Note that many (34%) benign masses have more than one characteristic of malignancy.

When does the chance of ovarian cancer increase enough that it is best to have the initial surgical exploration done by a gynecologic cancer surgeon specialist?

The authors in the Risk of Malignancy study used a scoring system by Jacobs (1990) based on the menopausal status (premenopausal = 1, postmenopausal = 3), ultrasound characteristics (zero or one characteristic ultrasound finding = 1, two or more features = 3) and the CA-125 level (actual value). They then multiply these three values together (RMI= M X U X Ca-125). For example, a postmenopausal woman (3) who had two ultrasound characteristics of malignancy (3) and had a CA-125 level of 50 u/ml, would have a risk of malignancy index (RMI) of 3x3x50 =300. In calculating RMIs for all the patients in their study, Tingulstad et al found a cutoff of RMI=300 which is used to predict whether there may be a malignancy present, if the RMI is 300 or over, 3 out of 4 times an ovarian malignancy will be present.

In this case without USG findings and CA-125 findings it would be impossible to predict treatment but surgical exploration would be best in the absence of above. Even a complex cyst in postmenopausal state is dangerous.

lazybonezzz · Credits: 54715 My Scrapbook

i think it shud b wait & watch coz no symptoms r mentioned& u cant go4 surgery with investigations so its relatively a better choice
opinions???

manpreet108 · Credits: 30682 My Scrapbook

thats a perfect explanation i was looking for ....thanks chand.

the ans given in guides is wait and watch but i wd go for surgicall exploration-with the detailed analysis mentioned .

manpreet108 · Credits: 30682 My Scrapbook

funtional cysts in ovary are less than 7 cm in size and they regress spontaneouly ...
but also note that size is not a criterion to evaluate malignant potential in a post menopausal women because OVARIES ARE NON FUNCTIONAL.

this was told in gyne lectures in UG.
the reason is very clear with the grading system quoted in the above extract.

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