What is an adnexal mass and what does it mean if a woman has an adnexal mass?

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KevinHolcombMD (Physician - OBGYN - Gynecologic Oncology (Verified) ) - 07 / 23 / 2012

The term “adnexa” refers to the area of the fallopian tubes and ovaries. Therefore, an adnexal mass is usually a mass involving the ovary or tube. Masses arising from the uterus or other nearby structures can be referred to as an adnexal mass on physical examination or imaging studies as well. Adnexal masses are typically found either as an abnormality of the pelvic examination or by pelvic imaging ( ie pelvic sonograms, CT scans, or MRI). Some masses cause symptoms such as pelvic pain or increasing girth of the abdomen while others may cause no symptoms at all. Adnexal masses may be fluid-filled (“cystic”), solid, or mixed with cystic and solid areas. The risk of malignancy is heavily influenced by the age of the woman, the imaging characteristics, and the family history of cancer. Ovarian and fallopian tube cancer is largely a disease of postmenopausal women (average age is approximately 61 years) so an adnexal mass in a postmenopausal woman carries a higher risk of malignancy than a mass in a premenopausal woman. It should be noted, however, that the majority of adnexal masses in postmenopausal women are benign. Malignant adnexal masses share some common characteristics on pelvic sonograms. They tend to be larger than benign masses, contain both solid and cystic components with vascular flow in the solid areas, are more often bilateral, and occasionally are associated with free fluid (ascites). Many benign masses share these characteristics and this lack of specificity limits the accuracy of pelvic sonograms for determining the risk of malignancy. A strong family history of breast, ovarian, uterine, and/or colon cancer should alert the gynecologist to the possibility of a familial cancer syndrome that would also increase the risk of malignancy in an adnexal mass. Lastly, the majority of ovarian cancers produce a glycoprotein called CA-125 that can be measured in the blood and used to monitor the progress of an ovarian cancer patient during chemotherapy. Many clinicians will also use this serum tumor marker in an attempt to assess the risk of malignancy in an adnexal mass. It should be noted that its lack of sensitivity (only 50% of early stage ovarian cancer patients have an elevated CA 125 level) and specificity (many benign gynecologic and non-gynecologic conditions can elevate CA 125) limits its usefulness in this setting. Despite these limitations, the American Congress of Obstetricians and Gynecologists and the Society of Gynecologic Oncologists have issued guidelines that instruct a general Gynecologist when it is appropriate to refer a woman with an adenxal mass to a Gynecologic Oncologist. These guidelines vary for pre and postmenopausal women and consider the physical findings, sonographic findings, the CA 125 levels. Recently, the Food and Drug Administration approved 2 new blood tests that have been proven to increase the accuracy of adnexal mass cancer risk assessment above the previously available tools. These tests are meant to aid in the triage of patients that are already scheduled for surgery to a Gynecologic Oncologist if they are determined to be at increased risk for cancer.
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