Masses of the ovary, fallopian tube or other pelvic organs may be incidental findings on examination or may present with symptoms of pain. The diagnostic evaluation determines need for and type of surgical or medical intervention.
Two FDA approved serum tumor marker panel tests, for use in women >18 years with an already identified adnexal mass that requires surgery
Serum biomarker panels may be used as an alternative to CA 125 level alone in determining the need for referral to or consultation with a gynecologic oncologist when an adnexal mass requires surgery
Evaluation of the patient with an adnexal mass is intended to exclude malignancy, identify patients in need of emergent surgery and allow appropriate scheduling for those who need nonemergent surgery. Patients with tubo-ovarian abscesses may respond to medical management or interventional radiologic drainage. Those with small cysts can often be followed with ultrasound in anticipation of spontaneous resolution. Metastatic cancers, especially from breast, colon or stomach may present as adnexal masses. Those with findings suggestive of malignancy should have consultation with or referral to a gynecologic oncologist.
Note: The ESGO/ISUOG/IOTA/ESGE Consensus Statement (see ‘Learn More – Primary Sources’ below) provides excellent summary tables on clinical and ultrasound features of adnexal masses
The ideal interval and duration for ultrasound follow-up has yet to be defined. However, in one study, masses that were monitored and eventually diagnosed as malignancies all demonstrated growth by 7 months . Some experts recommend limiting observation of stable masses without solid components to 1 year, and stable masses with solid components to 2 years.
ACOG Practice Bulletin No. 174: Evaluation and management of adnexal masses
NEJM Case 18-2019: A 24-Year-Old Woman with a Pelvic Mass
ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumors
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