Causes And Management Of Adnexal Tumours

Overview

An adnexal mass or tumour is defined as a lump in tissue near the uterus. Usually located in the fallopian tube or the ovaries. These masses can be ovarian cysts, ectopic pregnancy, or benign or malignant (cancerous) tumours.¹

The adnexa (from the Latin word meaning to tie or attach) is the area surrounding the uterus. It contains the ovaries and fallopian tube, as well as blood vessels, ligaments, and connective tissues. Adnexal masses or tumours are not age-specific.

They can occur at any age, but are most common at individuals assigned female at birth (AFAB) of childbearing age. They can be symptomatic, but they can also be discovered on routine examinations. Most adnexal masses are benign and thus don’t require any medical intervention as they will disappear on their own. However, they may occasionally need to be surgically removed.²

Symptoms of adnexal mass

Most adnexal tumours are asymptomatic (cause no symptoms), and are discovered during routine examinations. However, they can cause symptoms such as:³

• Pelvic or lower abdominal pain
• Abnormal bleeding from the uterus
• Difficulty in urination, or frequent urination
• Irregular period, especially for those going through menopause
• Painful periods
• Pain during intercourse
• Gastrointestinal symptoms, including a feeling of fullness, difficulty in eating, indigestion, bloating, constipation, nausea, and vomiting
• Weight loss
• Fatigue 
• Unusual vaginal discharge

Different types of adnexal masses can have similar symptoms. Your healthcare provider will use different diagnostic tools to determine the exact cause of the mass and how best to manage it.

Causes of adnexal tumours

Adnexal tumours can be of gynaecological or non-gynaecological origin. Most adnexal masses originate from the reproductive system, but they can originate from the digestive and urinary systems.⁴

Gynaecological adnexal tumours

Causes of gynaecological adnexal masses include:

• Ovarian cysts: these are painless, fluid-filled cysts that are usually asymptomatic. They are mostly discovered during routine examinations
• Ectopic pregnancy: occurs when a fertilised egg doesn’t make its way to the uterus and implants in the fallopian tube. Ectopic pregnancies cause severe pain and bleeding and can be very serious and fatal if left untreated
• Benign ovarian tumours: the growth of abnormal cells in the ovaries can cause solid masses that are non-cancerous. They are usually asymptomatic and don’t spread to other parts of the body
• Ovarian cancer: adnexal masses can be malignant tumours that can metastasise (spread) to the other parts of the body. Ovarian cancer is one of the most common types of cancer in individuals AFAB
• Hydrosalpinx: occurs when a fallopian tube fills with fluids. Usually, this doesn’t cause any symptoms, but it can sometimes cause pelvic pain
• Broad ligament leiomyoma: a uterine leiomyoma is a benign tumour of smooth muscles. They may be located in close proximity to the ovary and fallopian tube and thus be mistaken for an adnexal mass
• Abscess: abscesses are common side effects of genital infections. The infection can spread to cause inflammation of the fallopian tube and the surrounding structures

Non-gynaecological adnexal tumours

Non-gynaecological adnexal masses usually originate from the urinary or digestive system. These masses are often colon or appendix tumours. However, breast cancer and colon cancer can also spread and reach the adnexal region, where they cause adnexal masses to form.

Diagnosis

Adnexal tumours are mostly discovered during routine examinations, pelvic examinations, and ultrasounds. After a mass is detected, clinical symptoms and tumour markers are used to confirm a diagnosis. 

An ultrasound is the most accurate way to diagnose adnexal tumours. Transvaginal ultrasounds are preferred over transabdominal ultrasounds, but in cases where a transvaginal ultrasound can’t visualise the uterus, ovaries, or upper pelvis, a transabdominal ultrasound can be used for a better view.⁵

Management

The patient’s clinical presentation, symptoms, and age must all be considered when setting a treatment plan for an adnexal mass. Most adnexal masses are benign and spontaneously resolve on their own. However, regular monitoring of the mass is crucial to ensure the size stays the same, and no symptoms develop. 

Surgical interventions are based on the size of the mass. Any mass that is more than 10cm in diameter should be surgically explored, and a biopsy should be sent for further examination.² Malignant adnexal masses may require a different course of treatment depending on the nature of the malignancy and their stage at the time of diagnosis.

FAQs

How serious are adnexal masses?

Most adnexal mass cases are not serious, and the majority go on their own without intervention. However, in rare cases, the tumours can be malignant - demanding a more serious and time-sensitive approach for management.

Can adnexal masses be prevented?

Adnexal tumours can not be prevented, but regular gynaecological check-ups can help doctors catch them early and prevent further complications.

Summary

Adnexal tumours or masses refer to abnormal growths that occur in the adnexa of the uterus (which includes the ovaries, fallopian tubes, and surrounding connective tissues). These tumours can be benign or malignant and can occur at any age. Causes of adnexal masses include ovarian cysts, benign and malignant ovarian tumours, and ectopic pregnancy, to name a few.

Diagnosis typically involves a combination of physical examinations, imaging techniques such as ultrasound, and blood tests, including tumour markers. Once identified, the management of adnexal tumours can vary based on the size and the symptoms. Benign tumours may only require regular monitoring or minimally invasive procedures to remove them, while malignant mass treatment includes more radical approaches.

Early detection and tailored management strategies are critical for improving outcomes, particularly in malignant cases, emphasising the importance of regular gynaecological check-ups and seeking prompt medical attention when symptoms develop. Advances in medical research and treatment protocols continue to enhance the effectiveness of managing adnexal tumours, improving prognosis and quality of life for affected individuals.