Evaluation of an ovarian mass
An adnexal mass found on exam or incidental imaging is triaged by menopausal status, ultrasound morphology, and CA-125 into observation, gynecology referral, or urgent gynecologic-oncology referral. Getting this triage right avoids both unnecessary surgery on a physiologic cyst and delayed staging surgery on an early ovarian cancer.
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What this article covers
- Overview
An adnexal mass is a triage problem, not a diagnosis: most masses found on exam or incidental imaging are benign physiologic cysts, but the evaluation finds the minority that are malignant before…
- Epidemiology
Most ovarian masses are benign: functional cysts from cyclic ovulation are the most common cause of ovarian enlargement in the reproductive years.
- Risk factors
Increasing age, particularly postmenopausal status.
- Pathophysiology
Functional cysts arise from normal ovulatory cycling: a follicular cyst forms when a dominant follicle fails to rupture or involute; a corpus luteum cyst forms when the corpus luteum fails to…
- Clinical features
Most ovarian masses, benign and malignant alike, are asymptomatic and found incidentally; early-stage disease is typically not detected on routine pelvic exam.
- Differential diagnosis
Ectopic pregnancy: positive beta-hCG with an adnexal mass and no intrauterine pregnancy on ultrasound; check a pregnancy test first in any reproductive-age patient.
- Diagnosis
This is an imaging and biomarker triage, not a single test: the mass is characterized as benign-favoring or malignant-favoring by combining menopausal status, ultrasound morphology, and CA-125…
- Management
First, establish menopausal status and ultrasound morphology, since these set the observe-versus-refer threshold; add CA-125 only for masses that already look suspicious.
- Complications
Delayed diagnosis of malignancy from prolonged observation of a worrisome mass, allowing progression to advanced stage.
- Prognosis
Prognosis is dictated by histology and, for malignancy, by stage at diagnosis, not by the triage pathway itself.
- Prevention
Combined oral contraceptives for 5 or more years lower ovarian cancer risk by roughly 30-60%: one tablet PO daily (low-dose ethinyl estradiol 20-35 mcg formulation), 21 active days plus 7 placebo…
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