Pelvic masses and ovarian cysts are very common in females of all ages.
While benign ovarian masses are harmless, malignant masses (ovarian cancers) need to be recognised so that we can treat them accordingly and early. Unfortunately, no 100%-reliable tool is available to distinguish between benign and cancerous masses.
We use the patient’s age, features on medical imaging (ultrasound) and tumour markers (blood) to estimate the risk of cancer.
- In patients with a very low risk of cancer, we often recommend to monitor the cyst in 2 or 3 months’ periods
- Patients who develop symptoms (pain) but otherwise have a low risk of malignancy, surgery will be offered. Surgery can be with a general gynaecologist or a gynaecological oncologist
- Patients with a moderate or high risk of malignancy are offered expedited surgery and those patients may benefit from surgery through a gynaecological oncologist. Surgery with a gynaecological oncologist will save the patient an unnecessary second surgical procedure in case a malignancy is found
- Patients with a personal history of breast cancer or patients with a family history of breast, ovarian, pancreatic and other cancers may carry genes predisposing them to ovarian cancer
Pelvic masses can arise from the ovary but also from other structures in the pelvis such as the fallopian tube, the uterus, the bowel, appendix, or the kidney.
Adnexal masses potentially can be:
- Functional cysts including polycystic ovary syndrome
- Pregnancy-related (ectopic pregnancy)
- Inflammation/infection (Pelvic inflammatory disease, tubo-ovarian abscess)
- Endometriosis (endometrioma)
- Leiomyoma (arising from the uterus)
- True neoplasms (benign or malignant/cancerous): e.g. Ovarian cancer
- Cancers arising from somewhere else but spread to the ovary
Pelvic masses and ovarian cysts require surgical exploration if they are either considered as suspicious or if they cause symptoms (pain).
The likelihood that a pelvic mass is cancerous increases with age. All suspicious ovarian masses in menopausal women (except simple ovarian cysts) should be regarded as cancer unless proven otherwise.
Ultrasound, CT scan and tumour markers may point to the high probability of ovarian cancer but some types of ovarian cancer are extremely difficult to diagnose prior to surgery.