An adnexal mass is an abnormal growth in and around the area of the uterus, including luteum cysts, ectopic pregnancies, polycystic ovaries, and benign or malignant tumors. The treatment for these masses depends on the age of the woman, her symptoms, CA-125 blood tests results, and the size and structure of the adnexal mass. Small cyst-like masses are typically watched to see if they will be naturally reabsorbed. A large mass is reviewed using laparoscopic surgery, removed, and pathologically studied to determine if it is malignant.
For young girls between birth and the beginning of menstruation, an adnexal mass needs to be carefully and quickly reviewed using an ultrasound scan. This prompt evaluation is essential because it is unlikely that benign masses are present prior to reproductive age. Laparoscopic surgery will typically follow to remove and pathologically review the mass.
An adnexal mass in a premenopausal women will be reviewed with an ultrasound scan to determine the size and texture of the abnormality. A mass that is greater than 3.9 inches (10 cm) and solid will require laparoscopic surgery. During surgery, the mass will be removed and pathologically reviewed. Following extraction of the mass, the surrounding area will be observed for metastasis or any additional masses missed by the ultrasound.
Adnexal masses in premenopausal women less than 3.9 inches (10cm) that are cyst-like or fluid filled will be watched for approximately four to six weeks. Oral contraception may be given to control hormone levels and help shrink the mass. Most masses are reabsorbed during this period of time. If the mass grows during this time, exploratory laparoscopic surgery will be ordered to look at the mass, remove it, and pathologically review the tissue.
When a postmenopausal woman has an adnexal mass, a complete gynecological exam will be ordered. This will include a Papanicolaou smear, CA-125 blood test and an ultrasound. The CA-125 blood test looks for the benign and malignant tumor marker, CA-125. If the postmenopausal woman has a normal gynecological exam, Papanicolaou smear, CA-125 serum level, and the mass is less than 1.2 inches (3 cm), it will be watched and monitored using periodic ultrasound scans and CA-125 blood tests.
If the gynecological exam and Papanicolaou smear are normal and the CA-125 blood test is negative but the mass is greater than 1.2 inches (3 cm), laparoscopic surgery will be performed to inspect the mass and determine whether it is benign or malignant. When the postmenopausal woman has an elevated CA-125 serum level, an abnormal Papanicolaou smear, and the mass does not look cyst-like, laparoscopic surgery will be performed to remove the mass and ovaries and review the uterine area.
Whenever a malignancy is found, the mass will be removed along with most of or all of the reproductive organs and lymph nodes in the area. All of these structures will be reviewed pathologically to determine the extent of the cancer. The pathology results will determine the chemotherapy ordered following surgery. Benign masses will be removed along with the ovaries, and a thorough review of the area will look for any other masses.
