Adnexal masses are commonly known as ovarian cystsalthough the term refers to all tumors that affect the fallopian tubes or ovaries. These tumors can be diagnosed by producing symptoms that lead us to consult, but they can also accompany us for a long period of time without causing symptoms and be diagnosed in a routine gynecological examination.
«They are common conditions in women of all ages. Although they are more common in non-menopausal women, especially in the young population, among whom it has a prevalence of between 20 and 25 percent; They also affect one in ten postmenopausal women. In menopausal women, around 10 percent are malignant,” says Dr. Balbino Povedano, head of the Gynecology and Obstetrics Service at the Quirónsalud Córdoba Hospital.
Likewise, Dr. María Dolores Torres, a specialist in the Gynecology and Obstetrics Service of the same health center, recalls in this sense the importance of early diagnosis, as well as its impact on women’s health: «In menopausal women, ovarian cysts “They are less frequent (10%), but in these cases, the possibility of malignancy is greater.”
Main risk factors
As the expert details, among the risk factors when developing ovarian cysts would be: obesity, being a mother over 35 years of age, smoking, having a family history of ovarian cyst or ovarian cancer; or some syndromes, “but these are rarer causes.”
Furthermore, Dr. Povedano highlights that ovarian cysts are usually asymptomatic. When they do give symptoms, they are usually nonspecific. The most common symptoms are: pain, sensation of inflammation or fullness; or gastrointestinal symptoms, such as nausea, gas, vomiting, or constipation. They can also cause urinary symptoms due to pressure, such as urgency to urinate or bladder urgency (constant feeling of needing to urinate); in addition to abdominal swelling, pain during sexual intercourse, bleeding between periods, weight loss, or asthenia.
Confirm the suspicion
In turn, Dr. José María Martos, an expert in Diagnostic Imaging at Quirónsalud Córdoba, indicates that when a suspicion of these characteristics occurs, one or more of the following imaging tests are usually performed:
Gynecological ultrasound, which is performed by the gynecologist in consultation, and with which you can know if a cyst is benign, doubtful, or appears malignant, as well as the quantity, size of the cyst, and if further diagnostic tests are necessary.
If gynecological ultrasound is not sufficient to establish the diagnosis, Magnetic Resonance is used, “with great capacity to detect lesions”, while highlighting that it is a test that allows tissue characterization, in addition to anatomically detailing the ovary. . A CT scan can also be performed (when an MRI cannot be done), or if specific details about the cysts are wanted.
At this point, Dr. Balbino Povedano maintains that ovarian cyst surgery is indicated in emergent cases, that is, those that require immediate intervention, such as in some accidental ectopic pregnancies; in some very symptomatic ruptured hemorrhagic cysts; in case of serious infections; In addition, in benign cysts, more than 10 centimeters; or that produce some symptoms, such as pain or infertility. If a malignant cyst is suspected, a biopsy must be performed to ensure its malignant nature and, when optimal surgery is possible, the patient must undergo surgery to completely remove the malignant tumor. Sometimes, before operating, it is preferable to perform medical treatment, followed by surgery when the amount of malignant tumor has disappeared or decreased.
If there is ovarian cancer behind
Finally, Dr. María Jesús Rubio, head of the Medical Oncology Service at the Quirónsalud Córdoba Hospital, indicates what steps to follow when suspicion of a malignant lesion appears, compatible with a diagnosis of ovarian cancer: «The first thing you know “does are imaging studies, transvaginal ultrasound.”
Given data of high suspicion of a possible ovarian cancer, Dr. Rubio indicates that the results of the imaging tests, biopsy results and analyzes must be presented to a multidisciplinary tumor committee, where the extension, as well as the characteristics of the tumor, will be seen. tumor; and from there the possible therapeutic strategy. “Up to 70% of ovarian cancers are diagnosed in an advanced stage due to the characteristics of the disease,” he adds.
In this sense, José María Martos, an expert in Diagnostic Imaging at Quirónsalud Córdoba, details that when ovarian cysts begin to have a thicker or irregular wall, or there begins to be tissue that is not liquid with calcium or fat, that is when People are beginning to think that they are not simple cysts, which does not mean that they are necessarily malignant.
Currently, the most used surgical techniques for the removal of benign cysts are minimally invasive, such as laparoscopy or robotics as described by Dr. Povedano. A new technique called V-Notes has recently been introduced, available in selected cases, which allows the removal of adnexal masses vaginally, without the need for abdominal incisions.
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