General Measures
They include, after the diagnosis of a cystic or solid tumor of the lower abdomen, informing the patient as comprehensively as possible about necessary steps of diagnosis and differential diagnosis by obligatory ultrasonography, estimating the risk of malignancy (risk of malignancy) on the basis of anamnestic data and certain ultrasonographic criteria, and informing the patient about acute complication possibilities. Increased risk:
- As a result of anamnestic risk constellations.
- Family burden (relative risk with one ill relative 3.1, with two or more ill relatives 7.2)
- Early menarche/first menstrual period (< 11 years) (not unchallenged).
- Hormone therapy (peri- and postmenopausal).
- Infertility (infertility)
- Nulligravidity
- Late first pregnancy > 35 years
- Late menopause (> 55 years) (not unchallenged).
- Repeated ovulation-inducing measures with gonadotropins for infertility therapy (under discussion).
- Increasing age
- According to the following ultrasound criteria:
- Ascites (abdominal fluid)
- Irregular boundary of the tumor
- Multilocular cysts
- Papillary structures in the cystic portion
- Irregularly shaped solid tumor
- Irregular multilocular tumor with a maximum diameter of more than 7-10 cm.
- Doppler: markedly strong blood flow in the tumor in color Doppler.
Despite many efforts, so far by means of ultrasound, even in combination with tumor markers and proven risk constellations, differentiation between benign, malignant and borderline tumors is not possible. In about 7% of patients with adnexal tumors, such differentiation is not successful. This of course has consequences for the frequency of control examinations and for the decision of a surgical intervention. While additional diagnostics by means of computed tomography (CT) usually do not provide any significant new findings, magnetic resonance imaging (MRI) is often helpful in further differentiation. But even they can not solve the problem satisfactorily.
Acute complication possibilities:
- Rupture (bursting)
- Stem rotation
These complications necessitate acute inpatient intervention. They can be reduced by avoiding physical stress. Other general measures
- Aim for normal weight!Determine BMI (body mass index) or body composition by electrical impedance analysis and, if necessary, participate in a medically supervised weight-loss program.
- BMI ≥ 25 → participation in a medically supervised weight loss program.
Regular checkups
- As mentioned above, the frequency of check-ups and the decision whether and when to intervene surgically is and remains a subjective one between the affected person and the supervising physician. The following parameters may be helpful in making this decision:
- Premenopause (approximately ten to fifteen years before menopause/time of last spontaneous menstruation in a woman’s life):
- The incidence of ovarian cancer in persistent (lasting for a long period of time) adnexal findings is 6-11%.
- Approximately 18% of all ovarian cancers (ovarian cancer) occur during premenopause
- Monocysts (single cysts) without internal structure, < 7-10 cm, usually regress within three to six months
- Postmenopause (time after which the last bleeding has been absent for at least a year).
- The incidence of ovarian cancer in persistent adnexal findings is 30-40%.
- The incidence of ovarian cancer increases >50 years from 15.7/100,000 to 54/100,000
- Monocysts without internal structure, < 7 cm, may also regress in postmenopause
- Cysts < 1 cm are clinically insignificant (germinal epithelial cysts).
With conservative, wait-and-see behavior, an individual short-term palpation and ultrasound monitoring is inevitable, especially in postmenopause. In case of growth tendency or appearance of potential malignancy criteria (see above), surgical clarification must be made.
- Premenopause (approximately ten to fifteen years before menopause/time of last spontaneous menstruation in a woman’s life):
