Abstract
In the postmenopausal women, adnexal masses can have numerous etiologies. They can range from benign to neoplastic, with origins from a variety of organ systems. The diagnostic work up includes a thorough history, physical exam, as well as potential imaging and laboratory testing. There should be a low threshold for consultations with oncologists when there are cancer concerns. Specifically for gynecologic neoplasms, a referral to a gynecologic oncologist should be strongly considered. In this paper, there is particular attention to ovarian cancer given the gravity of delayed diagnosis.
Keywords: Adnexal mass, postmenopausal, ovarian cancer, ROMA, HE4, CA125, OVA.
Graphical Abstract
[2]
Available from:. https://www.cancer.org/content/dam/cancer-org/ research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/ 2017/cancer-facts-and-figures-2017.pdf (Accessed on: June 3, 2017).
[3]
Herzog TJ. The current treatment of recurrent ovarian cancer. Curr Oncol Rep 2006; 8(6): 448-54.
[4]
U.S. Cancer Statistics Working Group. United States Cancer Statistics:
1999–2014 Incidence and Mortality Web-based Report. Atlanta:
U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention and National Cancer Institute; 2017.
Available from:. www.cdc.gov/uscs (Accessed on: June 3, 2017).
[5]
Vang R, Shih Ie M, Kurman RJ. Ovarian low-grade and high-grade serous carcinoma: Pathogenesis, clinicopathologic and molecular biologic features, and diagnostic problems. Adv Anat Pathol 2009; 16(5): 267-82.
[6]
Matz M, Coleman MP, Sant M, et al. The histology of ovarian cancer: worldwide distribution and implications for international survival comparisons (CONCORD-2). Gynecol Oncol 2017; 144(2): 405-13.
[7]
Landen CN, Birrer MJ Jr, Sood AK. Early events in the pathogenesis of epithelial ovarian cancer. J Clin Oncol 2008; 26(6): 995-1005.
[8]
Singh N, Gilks CB, Wilkinson N, McCluggage WG. The secondary Mullerian system, field effect, BRCA, and tubal fimbria: Our evolving understanding of the origin of tubo-ovarian high-grade serous carcinoma and why assignment of primary site matters. Pathology 2015; 47(5): 423-31.
[9]
Kindelberger DW, Lee Y, Miron A, et al. Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: Evidence for a causal relationship. Am J Surg Pathol 2007; 31(2): 161-9.
[10]
Gostout BS, Brewer MA. Guidelines for referral of the patient with an adnexal mass. Clin Obstet Gynecol 2006; 49(3): 448-58.
[11]
Thompson D, Easton DF. Breast cancer linkage consortium. Cancer incidence in BRCA1 mutation carriers. J Natl Cancer Inst 2002; 94(18): 1358-65.
[12]
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Gynecologists’ committee on practice, practice bulletin no. 174: Evaluation and management of adnexal masses. Obstet Gynecol 2016; 128(5): e210-26.
[13]
Antoniou A, Pharoah PD, Narod S, et al. Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: A combined analysis of 22 studies. Am J Hum Genet 2003; 72(5): 1117-30.
[14]
Titus-Ernstoff L, Perez K, Carmer DW, Harlow BL, Baron JA, Greenberg ER. Menstrual and reproductive factors in relation to ovarian cancer risk. Br J Cancer 2001; 84(5): 714-21.
[15]
Padilla LA, Radosevich DM, Milad MP. Limitations of the pelvic examination for evaluation of the female pelvic organs. Int J Gynaecol Obstet 2005; 88(1): 84-8.
[16]
Timmerman D, Van Calster B, Testa A, et al. Predicting the risk of malignancy in adnexal masses based on the simple rules from the International Ovarian Tumor Analysis group. Am J Obstet Gynecol 2016; 214(4): 424-37.
[17]
Geomini P, Kruitwagen R, Bremer GL, Cnossen J, Mol BW. The accuracy of risk scores in predicting ovarian malignancy: A systematic review. Obstet Gynecol 2009; 113(2 Pt 1): 384-94.
[18]
Guerriero S, Alcazar JL, Ajossa S, et al. Transvaginal color Doppler imaging in the detection of ovarian cancer in a large study population. Int J Gynecol Cancer 2010; 20(5): 781-6.
[19]
Glaser GE, Torres M, Kim B, et al. Preoperative clues to guide
primary approach in advanced ovarian cancer (OC): The role of CT
findings to predict the extent of tumor dissemination. J Clin Oncol 2011. 29(Suppl): abstr e15541).
[20]
Spencer JA, Ghattamaneni S. MR imaging of the sonographically indeterminate adnexal mass. Radiology 2010; 256(3): 677-94.
[21]
Thomassin-Naggara I, Bazot M, Daraï E, Callard P, Thomassin J, Cuenod CA. Epithelial ovarian tumors: Value of dynamic contrast-enhanced MR imaging and correlation with tumor angiogenesis. Radiology 2008; 248(1): 148-59.
[22]
Sohaib SA, Mills TD, Sahdev A, et al. The role of magnetic resonance imaging and ultrasound in patients with adnexal masses. Clin Radiol 2005; 60(3): 340-8.
[23]
Anthoulakis C, Nikoloudis N. Pelvic MRI as the “gold standard” in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: A systematic review. Gynecol Oncol 2014; 132(3): 661-8.
[24]
Rockall AG, Cross A, Flanagan S, Moore E, Avril N. The role of FDG-PET/CT in gynaecological cancers. Cancer Imaging 2012; 12: 49-65.
[25]
Castellucci P, Perrone AM, Picchio M, et al. Diagnostic accuracy of 18F-FDG PET/CT in characterizing ovarian lesions and staging ovarian cancer: correlation with transvaginal ultrasonography, computed tomography, and histology. Nucl Med Commun 2007; 28(8): 589-95.
[26]
Longoria TC, Ueland FR, Zhang Z, et al. Clinical performance of a multivariate index assay for detecting early-stage ovarian cancer. Am J Obstet Gynecol 2014; 210(1): 78.e1-9.
[27]
Sölétormos G, Duffy MJ, Othman Abu Hassan S, et al. Clinical use of cancer biomarkers in epithelial ovarian cancer: Updated guidelines from the european group on tumor markers. Int J Gynecol Cancer 2016; 26(1): 43-51.
[28]
Granato T, Porpora MG, Longo F, Angeloni A, Manganaro L, Anastasi E. HE4 in the differential diagnosis of ovarian masses. Clin Chim Acta 2015; 446: 147-55.
[29]
Ueland FR, Desimone CP, Seamon LG, et al. Effectiveness of a multivariate index assay in the preoperative assessment of ovarian tumors. Obstet Gynecol 2011; 117(6): 1289-97.
[30]
Nowak M, Janas Ł, Stachowiak G, Stetkiewicz T, Wilczyński JR. Current clinical application of serum biomarkers to detect ovarian cancer. Przegl Menopauz 2015; 14(4): 254-9.
[31]
Eskander RN, Carpenter BA, Wu HG, Wolf JK. The clinical utility of an elevated-risk multivariate index assay score in ovarian cancer patients. Curr Med Res Opin 2016; 32(6): 1161-5.
[32]
Morgan RJ Jr, Alvarez RD, Armstrong DK, et al. Ovarian cancer, version 2.2013. J Natl Compr Canc Netw 2013; 11(10): 1199-209.
[33]
Moore RG, Miller MC, Disilvestro P, et al. Evaluation of the diagnostic accuracy of the risk of ovarian malignancy algorithm in women with a pelvic mass. Obstet Gynecol 2011; 118(2 Pt 1): 280-8.
[34]
Dayyani F, Uhlig S, Colson B, et al. Diagnostic performance of risk of ovarian malignancy algorithm against CA125 and HE4 in connection with ovarian cancer: A meta-analysis. Int J Gynecol Cancer 2016; 26(9): 1586-93.
[35]
Rauh-Hain JA, Melamed A, Buskwofie A, Schorge JO. Adnexal mass in the postmenopausal patient. Clin Obstet Gynecol 2015; 58(1): 53-65.
[36]
Fanfani F, Fagotti A, Ercoli A, et al. A prospective randomized study of laparoscopy and minilaparotomy in the management of benign adnexal masses. Hum Reprod 2004; 19(10): 2367-71.
[37]
Parker WH, Levine RL, Howard FM, Sansone B, Nerek JS. A multicenter study of laparoscopic management of selected cystic adnexal masses in postmenopausal women. J Am Coll Surg 1994; 179(6): 733-7.
[38]
Yuen PM, Yu KM, Yip SK, Lau WC, Rogers MS, Chang A. A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol 1997; 177(1): 109-14.
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