An adnexal mass is a lump of tissue in or near the female reproductive system, usually in an ovary or uterine tube. They are called "adnexal" because of their association with the adnexa of the uterus, which are appendages related to the uterus. These appendages include the tissue around the uterus, ovaries, and uterine tubes. Adnexal masses can also be called pelvic masses.
The symptoms of an adnexal mass can be crippling and severe, but more often, there are no presenting symptoms at all. These masses are usually discovered during pelvic exams, CT scans, or MRIs. When symptoms are present, they often present as:
- Pelvic pain
- Irregular menstrual cycle
- Difficulty urinating or the frequent urge to do so
- Constipation
- Gastrointestinal problems
The symptoms of adnexal masses often depend on the condition they're associated with, so some may have more severe symptoms than others. They can also mirror many other ailments, so a health care provider will need to determine the root cause of your problem.
The most common reasons behind adnexal masses are ovarian cysts, ectopic pregnancies, benign tumors, and ovarian cancer.
Ovarian cysts are sacs or pockets that form in an ovary or on the surface. There are ovaries on the left and right sides of the uterus, and many people develop ovarian cysts during their lifetime. Some people don't notice them because they don't typically cause discomfort and disappear on their own in a few months without treatment.
Some ovarian cysts can rupture, however, and cause serious health problems. For example, if your cyst is accompanied by vomiting, fever, pain, and dizziness, this could be the sign of a serious health emergency, and medical assistance would be immediately required.
An ectopic pregnancy, or tubal pregnancy, occurs when a fertilized egg grows outside of the uterus instead of in the uterine lining. These pregnancies often take place in a uterine tube and can cause serious complications. The egg cannot survive outside of the uterus, and severe bleeding could threaten the mother's life.
Some people are more at risk of developing an ectopic pregnancy than others. Smoking, inflammation or infections associated with sexually transmitted infections, and a history of a previous ectopic pregnancy are all risk factors for ectopic pregnancies.
Some adnexal masses are benign tumors or noncancerous growths. These growths won't spread to other body parts and don't usually pose any major threats. They grow slowly and are often only noticed during a routine exam.
Ovarian cancer could also cause a pelvic mass. Ovarian cancer starts in the ovaries and spreads throughout the abdomen if undetected. If it is detected before spreading, the chances of treating it effectively are greater.
Most pelvic masses are not cancerous. Only 5–10 percent of women will be diagnosed with one in their lifetime, and 15–20 percent of those masses are cancerous. The most important action upon discovering a malignant mass is diagnosing it and treating it as soon as possible. The faster a cancerous tumor or growth is diagnosed and removed and treatment begins, the better the outcome will be. The risk of a cancerous adnexal or pelvic mass increases with age, and postmenopausal people are at a greater risk than premenopausal people.
The location and cause of the adnexal mass will influence what types of treatment are used. People with ovarian cysts can have them surgically removed or wait for the cysts to go away on their own. Benign or malignant tumors are often removed by surgery. Malignant tumors are also treated with chemotherapy. Managing a pelvic mass caused by an ectopic pregnancy requires ending the pregnancy.
The surgery that's often used to remove a pelvic mass is called a laparotomy. In a laparotomy, an incision is made in the abdomen to explore potential problems and remove both benign and potentially cancerous growths.
Laparoscopic surgery, in which small incisions are made and a camera investigates the abdominal and reproductive organs, can also be performed. A laparoscopy is often preferred for small tumors because of its lower risk of complications and bleeding.
An ovarian cystectomy, where cysts are removed from an ovary, is often performed in conjunction with a laparoscopy.
Pelvic exams should be administered regularly as a part of a routine check-up. This can help health care providers discover masses before they become an issue. Some symptoms of pelvic masses are also symptoms of normal menstruation, like constipation before a period. However, if you are experiencing unusual symptoms or severe pelvic pain, talk to your provider to find the underlying cause. Some causes of pelvic masses, like ectopic pregnancies, can lead to the rupture of the uterine tube and cause serious bleeding. Emergency medical care should be sought immediately.
Occasionally, adnexal masses occur during pregnancy and can spontaneously resolve themselves, whether symptomatic or asymptomatic. A health care provider will monitor the risk posed to the mother based on the odds of malignancy, progression, and location. Laparoscopy is still the preferred operative method here, but concerns about the danger to an unborn child mean caution should be exercised.
Even if a pelvic mass is not malignant, its size and location could pose a medical threat. A mass that's in close proximity to vital organs needs to be addressed. Torsion refers to the twisting of an organ, such as ovary. Torsion cuts off blood flow to the twisted organ, and immediate action to restore blood flow is necessary to keep the organ from dying.
Adnexal masses are typically no cause for concern. You may develop one unknowingly, and it may resolve itself before it is ever detected. If you do develop a pelvic mass, a health care provider can monitor the growth and threat posed by the mass. An educated decision will then be made with you and your care provider, one that may involve medication, surgery, or no action at all. Any growths that are accompanied by severe pain or troubling symptoms should be treated as potentially serious issues.