Adnexal tumors are a group of growths or neoplasms that originate from the adnexal structures of the skin or mucous membranes. Adnexal structures are accessory organs associated with the skin and include the hair follicles, sweat glands, sebaceous glands, and nails.
In gynecology, adnexal tumors primarily involve the ovaries and fallopian tubes. These tumors can be benign (non-cancerous) or malignant (cancerous). Ovarian tumors are more common than fallopian tube tumors.
Benign Ovarian Tumors: These include common types like ovarian cysts and benign teratomas. They are usually not life-threatening and often don’t require aggressive treatment.
Malignant Ovarian Tumors: These are cancerous growths that can be of various types, such as epithelial ovarian cancer, germ cell tumors, and sex cord-stromal tumors. Epithelial ovarian cancer is the most common and often diagnosed at advanced stages.
Fallopian Tube Tumors: Tumors originating in the fallopian tubes are relatively rare but can be malignant. They are often treated with surgery and, if cancerous, may require additional treatments like chemotherapy.
Epidemiology
Ovarian tumors are relatively common among gynecological malignancies. The incidence of ovarian cancer varies by region and population. It is more common in developed countries compared to developing ones. In the United States, for example, ovarian cancer is the fifth most common cancer among women.
The risk of ovarian cancer increases with age, and most cases are diagnosed in women over the age of 50.
Ovarian tumors encompass a wide range of histological types. The most common type is epithelial ovarian cancer, accounting for most cases. Other less common types include germ cell tumors, sex cord-stromal tumors, and borderline tumors.
Anatomy
Pathophysiology
Adnexal tumors of the ovaries and fallopian tubes can arise from various cell types within these structures. The precise cell of origin often determines the histological type of the tumor. Common ovarian tumors include epithelial ovarian tumors, germ cell tumors, and sex cord-stromal tumors.
The development of adnexal tumors typically begins with genetic mutations or alterations that cause normal cells to transform into abnormal ones. These mutations can result from various factors, including genetic predisposition, environmental exposures, and inflammation.
The pathophysiology of benign and malignant adnexal tumors differs significantly. Benign tumors typically involve abnormal cell growth but lack the invasive and metastatic properties seen in malignant tumors. Malignant tumors, on the other hand, exhibit uncontrolled growth, invasion into surrounding tissues, and the potential to spread to distant organs.
Etiology
A family history of ovarian cancer or other gynecological cancers can increase the risk of developing adnexal tumors. Mutations in genes such as BRCA1 and BRCA2 are strongly associated with an elevated risk of ovarian and fallopian tube cancers.
Certain reproductive factors can influence the risk of adnexal tumors. These include nulliparity (never having given birth), early onset of menstruation, late menopause, and infertility.
Long-term use of estrogen-only hormone replacement therapy (HRT) has been associated with an increased risk of ovarian cancer. Combined HRT (estrogen plus progesterone) may have a lower risk.
Women with PCOS may have a slightly elevated risk of developing certain types of ovarian tumors, although the overall risk remains relatively low.
Genetics
Prognostic Factors
The specific histological type of the tumor is a crucial prognostic factor. Different types of adnexal tumors have varying clinical behaviors and outcomes. For example, some histological types of ovarian cancer, such as serous carcinoma, tend to be more aggressive than others.
Staging is a critical prognostic factor for malignant adnexal tumors. The stage indicates the extent of tumor spread within the body. Ovarian cancer is typically staged from I to IV, with lower stages indicating tumors confined to the ovaries or fallopian tubes and higher stages indicating more extensive spread.
Tumor grade is a measure of how closely the tumor cells resemble normal cells under the microscope. High-grade tumors often have more aggressive growth patterns and are associated with a poorer prognosis compared to low-grade tumors.
Clinical History
Germ cell tumors, particularly benign ones like mature teratomas (dermoid cysts), can occur in children and adolescents. Malignant germ cell tumors are less common in this age group but can still occur.
Most benign ovarian tumors, such as ovarian cysts, can develop during the reproductive years, which typically span from adolescence to menopause.
Epithelial ovarian cancer, the most common type of malignant ovarian tumor, is often diagnosed in women who are perimenopausal or postmenopausal, typically in their 50s and 60s.
Physical Examination
Abdominal Examination: Start with an inspection of the abdomen. Look for any visible signs of abdominal distension or asymmetry.
Palpate the abdomen gently to assess for any masses, tenderness, or areas of rigidity.
Pelvic Examination: A pelvic examination is a crucial part of the evaluation for adnexal tumors. The patient should be positioned on the examination table in lithotomy position with their feet in stirrups.
The examiner assesses the size, location, mobility, and consistency of any masses felt in the pelvis. Adnexal tumors may be palpable in this manner.
Vaginal Examination: A vaginal examination may be performed to assess the vaginal vault and the posterior cul-de-sac (rectouterine pouch) for any masses or abnormalities.
Rectal Examination: In certain situations, a rectal examination may be indicated to assess for rectal or rectovaginal involvement by the tumor.
This checks for any palpable masses, nodularity, or tenderness in the rectal area.
Age group
Associated comorbidity
Adnexal tumors, especially large ones, can cause pelvic pain and discomfort. This pain may be due to pressure on nearby structures or stretching of the ovarian capsule. Pain can also result from the torsion (twisting) of the adnexal tumor.
Large adnexal tumors can compress the bladder, leading to urinary frequency, urgency, or difficulty emptying the bladder. These symptoms can mimic those of urinary tract infections or other urinary conditions.
Adnexal tumors, especially when they become very large, can press against the gastrointestinal tract. This can result in symptoms such as abdominal bloating, changes in bowel habits, constipation, or diarrhea.
In cases of advanced ovarian cancer, the tumor can lead to the accumulation of fluid in the abdominal cavity, a condition known as ascites.
Associated activity
Acuity of presentation
Adnexal tumors are discovered incidentally during routine pelvic examinations or imaging studies (such as ultrasound or CT scans) performed for other reasons. These tumors may be small and not causing any noticeable symptoms.
Many adnexal tumors, especially benign ones like ovarian cysts or dermoid cysts (mature teratomas), can present with mild or chronic symptoms.
This occurs when an ovarian cyst or tumor twists on its blood supply, leading to severe and sudden pelvic pain, nausea, and vomiting. Ovarian torsion is a medical emergency.
A ruptured cyst can cause acute pelvic pain, potentially leading to a diagnosis if the patient seeks medical attention. Malignant adnexal tumors, particularly ovarian cancer, can present with symptoms that gradually worsen over time.
Differential Diagnoses
Benign Ovarian Conditions: These are common and usually resolve on their own. They can mimic the appearance of more concerning tumors on imaging.
Ovarian Teratomas: These benign tumors can contain hair, teeth, and other tissues and are often discovered incidentally.
Endometriomas: Cysts filled with endometrial tissue that can cause pain and mimic the appearance of ovarian tumors on imaging.
Malignant Ovarian Tumors: This includes various subtypes, such as serous, endometrioid, mucinous, and clear cell carcinomas.
Germ Cell Tumors: Malignant germ cell tumors can occur in the ovaries and may include dysgerminoma, yolk sac tumor, and others.
Pelvic Inflammatory Conditions: Pelvic Inflammatory Disease (PID): Infections of the reproductive organs can lead to pelvic pain and adnexal tenderness, which may be mistaken for an adnexal tumor.
Uterine Fibroids: Large uterine fibroids can sometimes be mistaken for adnexal masses, especially on physical examination.
Inflammatory Bowel Disease (IBD): Crohn’s disease or ulcerative colitis can lead to inflammation in the pelvis and cause symptoms that mimic adnexal disorders.
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Benign Adnexal Tumors: Many benign adnexal tumors, such as simple ovarian cysts or dermoid cysts (mature teratomas), may not require immediate treatment. Instead, they can be observed and monitored through regular follow-up appointments and imaging studies.
Surgical Removal: Surgical removal (oophorectomy or cystectomy) may be recommended for benign adnexal tumors that are causing significant symptoms, are large, or are at risk of complications such as torsion (twisting) or rupture.
Malignant Adnexal Tumors: In cases of malignant adnexal tumors, surgery is typically the primary treatment. Cytoreductive surgery aims to remove as much of the tumor as possible and is often followed by chemotherapy.
Fertility-Sparing Surgery: In select cases where fertility preservation is a priority and the tumor is at an early stage, fertility-sparing surgery may be considered. This approach aims to remove the tumor while preserving the uterus and at least one ovary.
Adjuvant Chemotherapy: After surgery, adjuvant chemotherapy may be recommended, especially for advanced-stage malignant adnexal tumors. The choice of chemotherapy regimen depends on the tumor type, stage, and patient factors.
Neoadjuvant Chemotherapy: In some cases, chemotherapy may be administered before surgery (neoadjuvant chemotherapy) to shrink the tumor and make it more operable.
Radiation Therapy: Radiation therapy is generally less commonly used for adnexal tumors but may be considered in specific situations, such as for certain types of rare or recurrent tumors.
Immunotherapy: Immunotherapy, such as immune checkpoint inhibitors, is being investigated as a treatment option for some types of adnexal tumors, primarily in clinical trials.
Diagnostic Imaging Facilities: Ensure access to advanced diagnostic imaging facilities, such as ultrasound, CT scans, and MRI, with expertise in gynecologic imaging to aid in accurate diagnosis and staging.
Pathology Services: Maintain high-quality pathology services for accurate histological diagnosis and tumor classification. Precise histology is essential for determining treatment plans.
Genetic Counseling and Testing: Offer genetic counseling and testing services, particularly for patients with a family history of ovarian cancer or known genetic mutations. Identifying high-risk individuals can influence management decisions.
Patient Support Services: Provide comprehensive patient support services, including counseling, support groups, and psychological support, as the diagnosis and treatment of adnexal tumors can be emotionally challenging.
Fertility Preservation: Offer fertility preservation options for eligible patients who wish to preserve their fertility before undergoing treatment. This may involve oocyte or embryo cryopreservation, as well as consultation with reproductive specialists.
Minimally Invasive Surgery: Promote the use of minimally invasive surgical techniques when appropriate, as they can reduce patient recovery time and complications.
Palliative Care: Ensure access to palliative care services to provide symptom management, pain control, and emotional support for patients with advanced or recurrent adnexal tumors.
Role of different Chemotherapies
Platinum-Based Chemotherapy: The most common chemotherapy regimen for treating advanced-stage ovarian cancer, including adnexal tumors, is a combination of platinum-based drugs and taxanes. These drugs are typically administered intravenously.
Single-Agent Chemotherapy: In single-agent chemotherapy with drugs like carboplatin or paclitaxel may be used, particularly for patients who cannot tolerate combination therapy.
Neoadjuvant Chemotherapy: Neoadjuvant chemotherapy is administered before surgery to shrink the tumor and make it more operable. It is often used for advanced-stage tumors or when surgery is initially deemed high-risk.
Paclitaxel: It is commonly used as part of a combination chemotherapy regimen for the treatment of malignant adnexal tumors. The combination typically includes paclitaxel and a platinum-based drug, such as carboplatin.
Paclitaxel is a key component in the standard chemotherapy regimens used for epithelial ovarian cancer, including serous, endometrioid, mucinous, and clear cell carcinomas.
Paclitaxel works by interfering with the normal function of microtubules in cells. Microtubules are essential for cell division, and paclitaxel disrupts their structure, preventing the division and growth of cancer cells. This leads to cell death and tumor shrinkage.
Role of antibiotics in people with pelvic inflammatory disease
Cefotetan and cefoxitin: They are both second-generation cephalosporin antibiotics that are commonly used as prophylactic antibiotics before surgery to reduce the risk of surgical site infections.
Clindamycin: Is another antibiotic that may be used for prophylaxis in cases of penicillin allergy.
These antibiotics are administered intravenously shortly before surgery to prevent potential bacterial infections associated with the surgical procedure.
Cystectomy: A cystectomy is the surgical removal of an ovarian cyst while preserving the affected ovary. It is commonly used for benign ovarian cysts, such as functional cysts or endometriomas.
Hysterectomy: In cases where the tumor or condition involves the uterus, a hysterectomy (removal of the uterus) may be performed in addition to other procedures. This is common in cases of uterine cancer.
Fertility-Sparing Surgery: In some cases, when adnexal tumors are found in young women who wish to preserve their fertility, fertility-sparing surgery may be considered. This approach aims to remove the tumor while preserving the uterus and at least one ovary.
Biopsy: A biopsy involves the removal of a tissue sample for pathological examination. It may be performed as part of the diagnostic process or during surgery to confirm the type and histology of the tumor.
Chemotherapy: Chemotherapy may be used as part of the treatment plan for malignant adnexal tumors, either before surgery to shrink the tumor or after surgery to target any remaining cancer cells.
use-of-phases-in-managing-adnexal-tumors
Staging Phase: For malignant adnexal tumors, staging is a critical step to determine the extent of disease spread. The staging system typically used for ovarian cancer is the FIGO (International Federation of Gynecology and Obstetrics) staging system.
Treatment Phases: Surgery is often a primary treatment for adnexal tumors. The type of surgery depends on the tumor characteristics. Options include oophorectomy (removal of one or both ovaries), salpingo-oophorectomy (removal of the fallopian tube and ovary), debulking surgery (removing as much tumor as possible in advanced cases), and sometimes fertility-sparing surgery.
Targeted Therapy and Immunotherapy: These newer treatment modalities may be considered for specific subtypes of adnexal tumors, particularly in clinical trial settings.
Supportive Care and Management: Patients with adnexal tumors often require supportive care to manage symptoms, side effects of treatment, and psychological support. Palliative care services may also be involved when appropriate.
Long-Term Care: For patients who have completed treatment and are in remission, long-term survivorship care focuses on monitoring for late effects of treatment, managing any potential long-term complications, and promoting overall health and well-being.
Medication
Future Trends
Media Gallary
References
Adnexal mass: Symptoms, treatment, and diagnosis (medicalnewstoday.com)
Adnexal Tumors: What Causes Them, and How They Are Treated (webmd.com)
Adnexal tumors are a group of growths or neoplasms that originate from the adnexal structures of the skin or mucous membranes. Adnexal structures are accessory organs associated with the skin and include the hair follicles, sweat glands, sebaceous glands, and nails.
In gynecology, adnexal tumors primarily involve the ovaries and fallopian tubes. These tumors can be benign (non-cancerous) or malignant (cancerous). Ovarian tumors are more common than fallopian tube tumors.
Benign Ovarian Tumors: These include common types like ovarian cysts and benign teratomas. They are usually not life-threatening and often don’t require aggressive treatment.
Malignant Ovarian Tumors: These are cancerous growths that can be of various types, such as epithelial ovarian cancer, germ cell tumors, and sex cord-stromal tumors. Epithelial ovarian cancer is the most common and often diagnosed at advanced stages.
Fallopian Tube Tumors: Tumors originating in the fallopian tubes are relatively rare but can be malignant. They are often treated with surgery and, if cancerous, may require additional treatments like chemotherapy.
Ovarian tumors are relatively common among gynecological malignancies. The incidence of ovarian cancer varies by region and population. It is more common in developed countries compared to developing ones. In the United States, for example, ovarian cancer is the fifth most common cancer among women.
The risk of ovarian cancer increases with age, and most cases are diagnosed in women over the age of 50.
Ovarian tumors encompass a wide range of histological types. The most common type is epithelial ovarian cancer, accounting for most cases. Other less common types include germ cell tumors, sex cord-stromal tumors, and borderline tumors.
Adnexal tumors of the ovaries and fallopian tubes can arise from various cell types within these structures. The precise cell of origin often determines the histological type of the tumor. Common ovarian tumors include epithelial ovarian tumors, germ cell tumors, and sex cord-stromal tumors.
The development of adnexal tumors typically begins with genetic mutations or alterations that cause normal cells to transform into abnormal ones. These mutations can result from various factors, including genetic predisposition, environmental exposures, and inflammation.
The pathophysiology of benign and malignant adnexal tumors differs significantly. Benign tumors typically involve abnormal cell growth but lack the invasive and metastatic properties seen in malignant tumors. Malignant tumors, on the other hand, exhibit uncontrolled growth, invasion into surrounding tissues, and the potential to spread to distant organs.
A family history of ovarian cancer or other gynecological cancers can increase the risk of developing adnexal tumors. Mutations in genes such as BRCA1 and BRCA2 are strongly associated with an elevated risk of ovarian and fallopian tube cancers.
Certain reproductive factors can influence the risk of adnexal tumors. These include nulliparity (never having given birth), early onset of menstruation, late menopause, and infertility.
Long-term use of estrogen-only hormone replacement therapy (HRT) has been associated with an increased risk of ovarian cancer. Combined HRT (estrogen plus progesterone) may have a lower risk.
Women with PCOS may have a slightly elevated risk of developing certain types of ovarian tumors, although the overall risk remains relatively low.
The specific histological type of the tumor is a crucial prognostic factor. Different types of adnexal tumors have varying clinical behaviors and outcomes. For example, some histological types of ovarian cancer, such as serous carcinoma, tend to be more aggressive than others.
Staging is a critical prognostic factor for malignant adnexal tumors. The stage indicates the extent of tumor spread within the body. Ovarian cancer is typically staged from I to IV, with lower stages indicating tumors confined to the ovaries or fallopian tubes and higher stages indicating more extensive spread.
Tumor grade is a measure of how closely the tumor cells resemble normal cells under the microscope. High-grade tumors often have more aggressive growth patterns and are associated with a poorer prognosis compared to low-grade tumors.
Germ cell tumors, particularly benign ones like mature teratomas (dermoid cysts), can occur in children and adolescents. Malignant germ cell tumors are less common in this age group but can still occur.
Most benign ovarian tumors, such as ovarian cysts, can develop during the reproductive years, which typically span from adolescence to menopause.
Epithelial ovarian cancer, the most common type of malignant ovarian tumor, is often diagnosed in women who are perimenopausal or postmenopausal, typically in their 50s and 60s.
Abdominal Examination: Start with an inspection of the abdomen. Look for any visible signs of abdominal distension or asymmetry.
Palpate the abdomen gently to assess for any masses, tenderness, or areas of rigidity.
Pelvic Examination: A pelvic examination is a crucial part of the evaluation for adnexal tumors. The patient should be positioned on the examination table in lithotomy position with their feet in stirrups.
The examiner assesses the size, location, mobility, and consistency of any masses felt in the pelvis. Adnexal tumors may be palpable in this manner.
Vaginal Examination: A vaginal examination may be performed to assess the vaginal vault and the posterior cul-de-sac (rectouterine pouch) for any masses or abnormalities.
Rectal Examination: In certain situations, a rectal examination may be indicated to assess for rectal or rectovaginal involvement by the tumor.
This checks for any palpable masses, nodularity, or tenderness in the rectal area.
Adnexal tumors, especially large ones, can cause pelvic pain and discomfort. This pain may be due to pressure on nearby structures or stretching of the ovarian capsule. Pain can also result from the torsion (twisting) of the adnexal tumor.
Large adnexal tumors can compress the bladder, leading to urinary frequency, urgency, or difficulty emptying the bladder. These symptoms can mimic those of urinary tract infections or other urinary conditions.
Adnexal tumors, especially when they become very large, can press against the gastrointestinal tract. This can result in symptoms such as abdominal bloating, changes in bowel habits, constipation, or diarrhea.
In cases of advanced ovarian cancer, the tumor can lead to the accumulation of fluid in the abdominal cavity, a condition known as ascites.
Adnexal tumors are discovered incidentally during routine pelvic examinations or imaging studies (such as ultrasound or CT scans) performed for other reasons. These tumors may be small and not causing any noticeable symptoms.
Many adnexal tumors, especially benign ones like ovarian cysts or dermoid cysts (mature teratomas), can present with mild or chronic symptoms.
This occurs when an ovarian cyst or tumor twists on its blood supply, leading to severe and sudden pelvic pain, nausea, and vomiting. Ovarian torsion is a medical emergency.
A ruptured cyst can cause acute pelvic pain, potentially leading to a diagnosis if the patient seeks medical attention. Malignant adnexal tumors, particularly ovarian cancer, can present with symptoms that gradually worsen over time.
Benign Ovarian Conditions: These are common and usually resolve on their own. They can mimic the appearance of more concerning tumors on imaging.
Ovarian Teratomas: These benign tumors can contain hair, teeth, and other tissues and are often discovered incidentally.
Endometriomas: Cysts filled with endometrial tissue that can cause pain and mimic the appearance of ovarian tumors on imaging.
Malignant Ovarian Tumors: This includes various subtypes, such as serous, endometrioid, mucinous, and clear cell carcinomas.
Germ Cell Tumors: Malignant germ cell tumors can occur in the ovaries and may include dysgerminoma, yolk sac tumor, and others.
Pelvic Inflammatory Conditions: Pelvic Inflammatory Disease (PID): Infections of the reproductive organs can lead to pelvic pain and adnexal tenderness, which may be mistaken for an adnexal tumor.
Uterine Fibroids: Large uterine fibroids can sometimes be mistaken for adnexal masses, especially on physical examination.
Inflammatory Bowel Disease (IBD): Crohn’s disease or ulcerative colitis can lead to inflammation in the pelvis and cause symptoms that mimic adnexal disorders.
Benign Adnexal Tumors: Many benign adnexal tumors, such as simple ovarian cysts or dermoid cysts (mature teratomas), may not require immediate treatment. Instead, they can be observed and monitored through regular follow-up appointments and imaging studies.
Surgical Removal: Surgical removal (oophorectomy or cystectomy) may be recommended for benign adnexal tumors that are causing significant symptoms, are large, or are at risk of complications such as torsion (twisting) or rupture.
Malignant Adnexal Tumors: In cases of malignant adnexal tumors, surgery is typically the primary treatment. Cytoreductive surgery aims to remove as much of the tumor as possible and is often followed by chemotherapy.
Fertility-Sparing Surgery: In select cases where fertility preservation is a priority and the tumor is at an early stage, fertility-sparing surgery may be considered. This approach aims to remove the tumor while preserving the uterus and at least one ovary.
Adjuvant Chemotherapy: After surgery, adjuvant chemotherapy may be recommended, especially for advanced-stage malignant adnexal tumors. The choice of chemotherapy regimen depends on the tumor type, stage, and patient factors.
Neoadjuvant Chemotherapy: In some cases, chemotherapy may be administered before surgery (neoadjuvant chemotherapy) to shrink the tumor and make it more operable.
Radiation Therapy: Radiation therapy is generally less commonly used for adnexal tumors but may be considered in specific situations, such as for certain types of rare or recurrent tumors.
Immunotherapy: Immunotherapy, such as immune checkpoint inhibitors, is being investigated as a treatment option for some types of adnexal tumors, primarily in clinical trials.
Psychiatry/Mental Health
Diagnostic Imaging Facilities: Ensure access to advanced diagnostic imaging facilities, such as ultrasound, CT scans, and MRI, with expertise in gynecologic imaging to aid in accurate diagnosis and staging.
Pathology Services: Maintain high-quality pathology services for accurate histological diagnosis and tumor classification. Precise histology is essential for determining treatment plans.
Genetic Counseling and Testing: Offer genetic counseling and testing services, particularly for patients with a family history of ovarian cancer or known genetic mutations. Identifying high-risk individuals can influence management decisions.
Patient Support Services: Provide comprehensive patient support services, including counseling, support groups, and psychological support, as the diagnosis and treatment of adnexal tumors can be emotionally challenging.
Fertility Preservation: Offer fertility preservation options for eligible patients who wish to preserve their fertility before undergoing treatment. This may involve oocyte or embryo cryopreservation, as well as consultation with reproductive specialists.
Minimally Invasive Surgery: Promote the use of minimally invasive surgical techniques when appropriate, as they can reduce patient recovery time and complications.
Palliative Care: Ensure access to palliative care services to provide symptom management, pain control, and emotional support for patients with advanced or recurrent adnexal tumors.
Oncology, Medical
Platinum-Based Chemotherapy: The most common chemotherapy regimen for treating advanced-stage ovarian cancer, including adnexal tumors, is a combination of platinum-based drugs and taxanes. These drugs are typically administered intravenously.
Single-Agent Chemotherapy: In single-agent chemotherapy with drugs like carboplatin or paclitaxel may be used, particularly for patients who cannot tolerate combination therapy.
Neoadjuvant Chemotherapy: Neoadjuvant chemotherapy is administered before surgery to shrink the tumor and make it more operable. It is often used for advanced-stage tumors or when surgery is initially deemed high-risk.
Paclitaxel: It is commonly used as part of a combination chemotherapy regimen for the treatment of malignant adnexal tumors. The combination typically includes paclitaxel and a platinum-based drug, such as carboplatin.
Paclitaxel is a key component in the standard chemotherapy regimens used for epithelial ovarian cancer, including serous, endometrioid, mucinous, and clear cell carcinomas.
Paclitaxel works by interfering with the normal function of microtubules in cells. Microtubules are essential for cell division, and paclitaxel disrupts their structure, preventing the division and growth of cancer cells. This leads to cell death and tumor shrinkage.
Oncology, Other
Cefotetan and cefoxitin: They are both second-generation cephalosporin antibiotics that are commonly used as prophylactic antibiotics before surgery to reduce the risk of surgical site infections.
Clindamycin: Is another antibiotic that may be used for prophylaxis in cases of penicillin allergy.
These antibiotics are administered intravenously shortly before surgery to prevent potential bacterial infections associated with the surgical procedure.
Surgery, General
Cystectomy: A cystectomy is the surgical removal of an ovarian cyst while preserving the affected ovary. It is commonly used for benign ovarian cysts, such as functional cysts or endometriomas.
Hysterectomy: In cases where the tumor or condition involves the uterus, a hysterectomy (removal of the uterus) may be performed in addition to other procedures. This is common in cases of uterine cancer.
Fertility-Sparing Surgery: In some cases, when adnexal tumors are found in young women who wish to preserve their fertility, fertility-sparing surgery may be considered. This approach aims to remove the tumor while preserving the uterus and at least one ovary.
Biopsy: A biopsy involves the removal of a tissue sample for pathological examination. It may be performed as part of the diagnostic process or during surgery to confirm the type and histology of the tumor.
Chemotherapy: Chemotherapy may be used as part of the treatment plan for malignant adnexal tumors, either before surgery to shrink the tumor or after surgery to target any remaining cancer cells.
Physical Medicine and Rehabilitation
Staging Phase: For malignant adnexal tumors, staging is a critical step to determine the extent of disease spread. The staging system typically used for ovarian cancer is the FIGO (International Federation of Gynecology and Obstetrics) staging system.
Treatment Phases: Surgery is often a primary treatment for adnexal tumors. The type of surgery depends on the tumor characteristics. Options include oophorectomy (removal of one or both ovaries), salpingo-oophorectomy (removal of the fallopian tube and ovary), debulking surgery (removing as much tumor as possible in advanced cases), and sometimes fertility-sparing surgery.
Targeted Therapy and Immunotherapy: These newer treatment modalities may be considered for specific subtypes of adnexal tumors, particularly in clinical trial settings.
Supportive Care and Management: Patients with adnexal tumors often require supportive care to manage symptoms, side effects of treatment, and psychological support. Palliative care services may also be involved when appropriate.
Long-Term Care: For patients who have completed treatment and are in remission, long-term survivorship care focuses on monitoring for late effects of treatment, managing any potential long-term complications, and promoting overall health and well-being.
Adnexal mass: Symptoms, treatment, and diagnosis (medicalnewstoday.com)
Adnexal Tumors: What Causes Them, and How They Are Treated (webmd.com)
medtigo
Adnexal Tumors
Updated :
October 9, 2023
Adnexal tumors are a group of growths or neoplasms that originate from the adnexal structures of the skin or mucous membranes. Adnexal structures are accessory organs associated with the skin and include the hair follicles, sweat glands, sebaceous glands, and nails.
In gynecology, adnexal tumors primarily involve the ovaries and fallopian tubes. These tumors can be benign (non-cancerous) or malignant (cancerous). Ovarian tumors are more common than fallopian tube tumors.
Benign Ovarian Tumors: These include common types like ovarian cysts and benign teratomas. They are usually not life-threatening and often don’t require aggressive treatment.
Malignant Ovarian Tumors: These are cancerous growths that can be of various types, such as epithelial ovarian cancer, germ cell tumors, and sex cord-stromal tumors. Epithelial ovarian cancer is the most common and often diagnosed at advanced stages.
Fallopian Tube Tumors: Tumors originating in the fallopian tubes are relatively rare but can be malignant. They are often treated with surgery and, if cancerous, may require additional treatments like chemotherapy.
Ovarian tumors are relatively common among gynecological malignancies. The incidence of ovarian cancer varies by region and population. It is more common in developed countries compared to developing ones. In the United States, for example, ovarian cancer is the fifth most common cancer among women.
The risk of ovarian cancer increases with age, and most cases are diagnosed in women over the age of 50.
Ovarian tumors encompass a wide range of histological types. The most common type is epithelial ovarian cancer, accounting for most cases. Other less common types include germ cell tumors, sex cord-stromal tumors, and borderline tumors.
Adnexal tumors of the ovaries and fallopian tubes can arise from various cell types within these structures. The precise cell of origin often determines the histological type of the tumor. Common ovarian tumors include epithelial ovarian tumors, germ cell tumors, and sex cord-stromal tumors.
The development of adnexal tumors typically begins with genetic mutations or alterations that cause normal cells to transform into abnormal ones. These mutations can result from various factors, including genetic predisposition, environmental exposures, and inflammation.
The pathophysiology of benign and malignant adnexal tumors differs significantly. Benign tumors typically involve abnormal cell growth but lack the invasive and metastatic properties seen in malignant tumors. Malignant tumors, on the other hand, exhibit uncontrolled growth, invasion into surrounding tissues, and the potential to spread to distant organs.
A family history of ovarian cancer or other gynecological cancers can increase the risk of developing adnexal tumors. Mutations in genes such as BRCA1 and BRCA2 are strongly associated with an elevated risk of ovarian and fallopian tube cancers.
Certain reproductive factors can influence the risk of adnexal tumors. These include nulliparity (never having given birth), early onset of menstruation, late menopause, and infertility.
Long-term use of estrogen-only hormone replacement therapy (HRT) has been associated with an increased risk of ovarian cancer. Combined HRT (estrogen plus progesterone) may have a lower risk.
Women with PCOS may have a slightly elevated risk of developing certain types of ovarian tumors, although the overall risk remains relatively low.
The specific histological type of the tumor is a crucial prognostic factor. Different types of adnexal tumors have varying clinical behaviors and outcomes. For example, some histological types of ovarian cancer, such as serous carcinoma, tend to be more aggressive than others.
Staging is a critical prognostic factor for malignant adnexal tumors. The stage indicates the extent of tumor spread within the body. Ovarian cancer is typically staged from I to IV, with lower stages indicating tumors confined to the ovaries or fallopian tubes and higher stages indicating more extensive spread.
Tumor grade is a measure of how closely the tumor cells resemble normal cells under the microscope. High-grade tumors often have more aggressive growth patterns and are associated with a poorer prognosis compared to low-grade tumors.
Germ cell tumors, particularly benign ones like mature teratomas (dermoid cysts), can occur in children and adolescents. Malignant germ cell tumors are less common in this age group but can still occur.
Most benign ovarian tumors, such as ovarian cysts, can develop during the reproductive years, which typically span from adolescence to menopause.
Epithelial ovarian cancer, the most common type of malignant ovarian tumor, is often diagnosed in women who are perimenopausal or postmenopausal, typically in their 50s and 60s.
Abdominal Examination: Start with an inspection of the abdomen. Look for any visible signs of abdominal distension or asymmetry.
Palpate the abdomen gently to assess for any masses, tenderness, or areas of rigidity.
Pelvic Examination: A pelvic examination is a crucial part of the evaluation for adnexal tumors. The patient should be positioned on the examination table in lithotomy position with their feet in stirrups.
The examiner assesses the size, location, mobility, and consistency of any masses felt in the pelvis. Adnexal tumors may be palpable in this manner.
Vaginal Examination: A vaginal examination may be performed to assess the vaginal vault and the posterior cul-de-sac (rectouterine pouch) for any masses or abnormalities.
Rectal Examination: In certain situations, a rectal examination may be indicated to assess for rectal or rectovaginal involvement by the tumor.
This checks for any palpable masses, nodularity, or tenderness in the rectal area.
Adnexal tumors, especially large ones, can cause pelvic pain and discomfort. This pain may be due to pressure on nearby structures or stretching of the ovarian capsule. Pain can also result from the torsion (twisting) of the adnexal tumor.
Large adnexal tumors can compress the bladder, leading to urinary frequency, urgency, or difficulty emptying the bladder. These symptoms can mimic those of urinary tract infections or other urinary conditions.
Adnexal tumors, especially when they become very large, can press against the gastrointestinal tract. This can result in symptoms such as abdominal bloating, changes in bowel habits, constipation, or diarrhea.
In cases of advanced ovarian cancer, the tumor can lead to the accumulation of fluid in the abdominal cavity, a condition known as ascites.
Adnexal tumors are discovered incidentally during routine pelvic examinations or imaging studies (such as ultrasound or CT scans) performed for other reasons. These tumors may be small and not causing any noticeable symptoms.
Many adnexal tumors, especially benign ones like ovarian cysts or dermoid cysts (mature teratomas), can present with mild or chronic symptoms.
This occurs when an ovarian cyst or tumor twists on its blood supply, leading to severe and sudden pelvic pain, nausea, and vomiting. Ovarian torsion is a medical emergency.
A ruptured cyst can cause acute pelvic pain, potentially leading to a diagnosis if the patient seeks medical attention. Malignant adnexal tumors, particularly ovarian cancer, can present with symptoms that gradually worsen over time.
Benign Ovarian Conditions: These are common and usually resolve on their own. They can mimic the appearance of more concerning tumors on imaging.
Ovarian Teratomas: These benign tumors can contain hair, teeth, and other tissues and are often discovered incidentally.
Endometriomas: Cysts filled with endometrial tissue that can cause pain and mimic the appearance of ovarian tumors on imaging.
Malignant Ovarian Tumors: This includes various subtypes, such as serous, endometrioid, mucinous, and clear cell carcinomas.
Germ Cell Tumors: Malignant germ cell tumors can occur in the ovaries and may include dysgerminoma, yolk sac tumor, and others.
Pelvic Inflammatory Conditions: Pelvic Inflammatory Disease (PID): Infections of the reproductive organs can lead to pelvic pain and adnexal tenderness, which may be mistaken for an adnexal tumor.
Uterine Fibroids: Large uterine fibroids can sometimes be mistaken for adnexal masses, especially on physical examination.
Inflammatory Bowel Disease (IBD): Crohn’s disease or ulcerative colitis can lead to inflammation in the pelvis and cause symptoms that mimic adnexal disorders.
Benign Adnexal Tumors: Many benign adnexal tumors, such as simple ovarian cysts or dermoid cysts (mature teratomas), may not require immediate treatment. Instead, they can be observed and monitored through regular follow-up appointments and imaging studies.
Surgical Removal: Surgical removal (oophorectomy or cystectomy) may be recommended for benign adnexal tumors that are causing significant symptoms, are large, or are at risk of complications such as torsion (twisting) or rupture.
Malignant Adnexal Tumors: In cases of malignant adnexal tumors, surgery is typically the primary treatment. Cytoreductive surgery aims to remove as much of the tumor as possible and is often followed by chemotherapy.
Fertility-Sparing Surgery: In select cases where fertility preservation is a priority and the tumor is at an early stage, fertility-sparing surgery may be considered. This approach aims to remove the tumor while preserving the uterus and at least one ovary.
Adjuvant Chemotherapy: After surgery, adjuvant chemotherapy may be recommended, especially for advanced-stage malignant adnexal tumors. The choice of chemotherapy regimen depends on the tumor type, stage, and patient factors.
Neoadjuvant Chemotherapy: In some cases, chemotherapy may be administered before surgery (neoadjuvant chemotherapy) to shrink the tumor and make it more operable.
Radiation Therapy: Radiation therapy is generally less commonly used for adnexal tumors but may be considered in specific situations, such as for certain types of rare or recurrent tumors.
Immunotherapy: Immunotherapy, such as immune checkpoint inhibitors, is being investigated as a treatment option for some types of adnexal tumors, primarily in clinical trials.
Psychiatry/Mental Health
Diagnostic Imaging Facilities: Ensure access to advanced diagnostic imaging facilities, such as ultrasound, CT scans, and MRI, with expertise in gynecologic imaging to aid in accurate diagnosis and staging.
Pathology Services: Maintain high-quality pathology services for accurate histological diagnosis and tumor classification. Precise histology is essential for determining treatment plans.
Genetic Counseling and Testing: Offer genetic counseling and testing services, particularly for patients with a family history of ovarian cancer or known genetic mutations. Identifying high-risk individuals can influence management decisions.
Patient Support Services: Provide comprehensive patient support services, including counseling, support groups, and psychological support, as the diagnosis and treatment of adnexal tumors can be emotionally challenging.
Fertility Preservation: Offer fertility preservation options for eligible patients who wish to preserve their fertility before undergoing treatment. This may involve oocyte or embryo cryopreservation, as well as consultation with reproductive specialists.
Minimally Invasive Surgery: Promote the use of minimally invasive surgical techniques when appropriate, as they can reduce patient recovery time and complications.
Palliative Care: Ensure access to palliative care services to provide symptom management, pain control, and emotional support for patients with advanced or recurrent adnexal tumors.
Oncology, Medical
Platinum-Based Chemotherapy: The most common chemotherapy regimen for treating advanced-stage ovarian cancer, including adnexal tumors, is a combination of platinum-based drugs and taxanes. These drugs are typically administered intravenously.
Single-Agent Chemotherapy: In single-agent chemotherapy with drugs like carboplatin or paclitaxel may be used, particularly for patients who cannot tolerate combination therapy.
Neoadjuvant Chemotherapy: Neoadjuvant chemotherapy is administered before surgery to shrink the tumor and make it more operable. It is often used for advanced-stage tumors or when surgery is initially deemed high-risk.
Paclitaxel: It is commonly used as part of a combination chemotherapy regimen for the treatment of malignant adnexal tumors. The combination typically includes paclitaxel and a platinum-based drug, such as carboplatin.
Paclitaxel is a key component in the standard chemotherapy regimens used for epithelial ovarian cancer, including serous, endometrioid, mucinous, and clear cell carcinomas.
Paclitaxel works by interfering with the normal function of microtubules in cells. Microtubules are essential for cell division, and paclitaxel disrupts their structure, preventing the division and growth of cancer cells. This leads to cell death and tumor shrinkage.
Oncology, Other
Cefotetan and cefoxitin: They are both second-generation cephalosporin antibiotics that are commonly used as prophylactic antibiotics before surgery to reduce the risk of surgical site infections.
Clindamycin: Is another antibiotic that may be used for prophylaxis in cases of penicillin allergy.
These antibiotics are administered intravenously shortly before surgery to prevent potential bacterial infections associated with the surgical procedure.
Surgery, General
Cystectomy: A cystectomy is the surgical removal of an ovarian cyst while preserving the affected ovary. It is commonly used for benign ovarian cysts, such as functional cysts or endometriomas.
Hysterectomy: In cases where the tumor or condition involves the uterus, a hysterectomy (removal of the uterus) may be performed in addition to other procedures. This is common in cases of uterine cancer.
Fertility-Sparing Surgery: In some cases, when adnexal tumors are found in young women who wish to preserve their fertility, fertility-sparing surgery may be considered. This approach aims to remove the tumor while preserving the uterus and at least one ovary.
Biopsy: A biopsy involves the removal of a tissue sample for pathological examination. It may be performed as part of the diagnostic process or during surgery to confirm the type and histology of the tumor.
Chemotherapy: Chemotherapy may be used as part of the treatment plan for malignant adnexal tumors, either before surgery to shrink the tumor or after surgery to target any remaining cancer cells.
Physical Medicine and Rehabilitation
Staging Phase: For malignant adnexal tumors, staging is a critical step to determine the extent of disease spread. The staging system typically used for ovarian cancer is the FIGO (International Federation of Gynecology and Obstetrics) staging system.
Treatment Phases: Surgery is often a primary treatment for adnexal tumors. The type of surgery depends on the tumor characteristics. Options include oophorectomy (removal of one or both ovaries), salpingo-oophorectomy (removal of the fallopian tube and ovary), debulking surgery (removing as much tumor as possible in advanced cases), and sometimes fertility-sparing surgery.
Targeted Therapy and Immunotherapy: These newer treatment modalities may be considered for specific subtypes of adnexal tumors, particularly in clinical trial settings.
Supportive Care and Management: Patients with adnexal tumors often require supportive care to manage symptoms, side effects of treatment, and psychological support. Palliative care services may also be involved when appropriate.
Long-Term Care: For patients who have completed treatment and are in remission, long-term survivorship care focuses on monitoring for late effects of treatment, managing any potential long-term complications, and promoting overall health and well-being.
Adnexal mass: Symptoms, treatment, and diagnosis (medicalnewstoday.com)
Adnexal Tumors: What Causes Them, and How They Are Treated (webmd.com)
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