Malignancy

Modified 14:16, 21 Jun 2012 by Anonymous? | Page History
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    Cervical Cancer

    Pathology:
     
     

    Ovarian Cysts

    • Usually benign
    • Do not cause pain, unless extremely large, or there is torsion, or hemorrhage
    • Investigate with U/S; (i.e. hemorrhagic cyst, may be causing pain).
    • Can decrease in size with OCP?

     

    Table 1: The risk of malignancy index (RMI) scoring system

     

    Feature RMI 1 Score RMI 2 Score

    Ultrasound features:

    • multilocular cyst
    • solid areas
    • bilateral lesions
    • scites
    • intra-abdominal metastases

    0= none
    1= one abnormality
    3= two or more abnormalities

     

    0= none
    1= one abnormality
    4= two or more abnormalities

     

    Premenopausal 1 1
    Postmenopausal 3 4
    CA125 U/ml U/ml
    RMI score = ultrasound score x menopausal score x CA125 level in U/ml.

    Four cohort studies exploring the role of RMI scores were identified.  Three of these studies compared the two RMI scores using cut-off values above 200 to indicate malignancy.  The RMI 2 score was more sensitive than the RMI 1 system with results of 74 to 80% at a specificity of 89 to 92% and positive predictive values around 80%.  Evidence level 2+

    Fibroids

    • Aka leiomyoma
    • Usually beign
    • Pain: usually no pain Except:
      • submucosal or pedunculated and undergoing torsion
      • undergoing "Red Degeneration" - fast growth in high-estrogen environment (i.e. pregnancy), and outgrowing blood supply.
    • Usually present with bleeding (especially if submucosal) and may cause infertility.
    • Often co-exist with endometriosis.
    • Can decrease in size or limit growth and bleeding with OCP.
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