Adnexal tumors and masses

Adnexal tumors and masses are growths of cells that form on the organs and connective tissue around the uterus. Adnexal tumors and masses most often aren't cancer, but they can be cancer.

Adnexal tumors and masses happen in the:

• Ovaries. The female reproductive system has two ovaries, one on each side of the uterus. They make eggs, called ova. The ovaries also make the hormones estrogen and progesterone.
• Fallopian tubes. The fallopian tubes connect the ovaries to the uterus.
• Connective tissue. Connective tissue surrounds and supports the ovaries and fallopian tubes.

Diagnosis of adnexal tumors and masses involves a careful physical exam, imaging tests and blood tests. Treatment depends on the size of the tumor or mass and its cause.

Many adnexal tumors and masses don't cause symptoms. They're often found during a medical exam that's done for another reason.

When adnexal tumors and masses cause symptoms, the symptoms may include:

• Pain, including pain in the pelvis or belly, painful period cramps that are worse than usual, and painful sex.
• A feeling of fullness or pressure in the pelvis or belly, or feeling full quickly when eating.
• Nausea and vomiting.
• Constipation or bloating.
• Urinating a lot or having trouble urinating.
• Bleeding from the vagina that is out of the ordinary.
• Fever.

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

If you have any of the following symptoms, get emergency medical care right away:

• Terrible pelvic or belly pain.
• Pelvic or belly pain that starts quickly.
• Bleeding from the vagina during the first three months of pregnancy.

There are many possible causes of adnexal tumors and masses. Causes that are more common include:

• Cysts. When fluid builds up in an area of the body, the mass that forms is called a cyst. Cysts can happen within the ovaries and fallopian tubes as well as in the connective tissue around them.
• Endometriosis. Endometriosis happens when tissue that is similar to the inner lining of the uterus grows outside the uterus. It often affects the ovaries, fallopian tubes and the tissue lining the pelvis.
• Ectopic pregnancy. An ectopic pregnancy happens when a fertilized egg implants and grows outside the main cavity of the uterus, most often in a fallopian tube.

Examples of other health conditions that can lead to adnexal tumors and masses include:

• Fibrosis. Fibrosis is a condition that happens when connective tissue becomes thick and scarred.
• Hydrosalpinx. Hydrosalpinx is when fluid blocks a fallopian tube.
• Infection. An infection may cause pus to build up and form a mass, called an abscess.
• Ovarian torsion. Ovarian torsion happens when an ovary moves out of its typical position and becomes twisted.
• Cancer. Most adnexal tumors and masses are not cancer. But some may be cancer that affects the ovaries, fallopian tubes or the tissue around them.

Because so many conditions can cause adnexal tumors and masses, there are many things that can raise the risk of developing them. But it's most important to be aware of factors that can affect the risk of an adnexal tumor or mass being cancer, including:

• Menopause. People who have gone through menopause are more likely to have an adnexal tumor or mass that is cancer than are people who haven't gone through menopause.
• Hormone medicines. People who have used infertility medicines with hormones are at a higher risk of a cancerous adnexal tumor or mass. But those who have used hormonal birth control are at a much lower risk of an adnexal tumor or mass being cancer.
• Family medical history. People with family members who have had breast cancer, ovarian cancer or fallopian tube cancer are at higher risk of developing a cancerous adnexal tumor or mass.
• Inherited DNA changes. DNA changes that raise the risk of cancer can be passed from parents to children. These changes can greatly raise the risk of getting some cancers. But not everyone with these DNA changes gets cancer.
• Smoking cigarettes. Cigarette smoking raises the risk of developing an adnexal tumor or mass that is cancer.

To diagnose adnexal tumors and masses, a healthcare professional may start with a pelvic exam. Other tests and procedures might include imaging tests and blood tests.

Pelvic exam

During a pelvic exam, a healthcare professional puts gloved fingers into the vagina and presses a hand on the belly at the same time in order to feel the pelvic organs. A pelvic exam also involves looking at the external genitals, vagina and cervix.

Imaging tests

Imaging tests make pictures of the body. They can show the location and size of an adnexal tumor or mass. Tests might include an ultrasound, computerized tomography scan, also called CT scan, and magnetic resonance imaging, also called MRI.

Blood tests

Blood tests may be done to help diagnose an adnexal tumor or mass, including:

• A pregnancy test.
• Blood tests to find an infection.
• A blood test for tumor markers that may be signs of cancer. For example, the cancer antigen 125 test, also called CA 125 test, can find a protein that's often found on the surface of ovarian cancer cells.

Treatment for adnexal tumors and masses depends on the type of growth and what's causing it. In some situations, such as with a small cyst, no treatment may be needed.

Surgery to remove an adnexal tumor or mass may be advised if the tumor or mass is large, if it's causing symptoms or if it could be cancer.

If you have any symptoms that worry you, start by making an appointment with a doctor or other healthcare professional. If your health professional suspects that an adnexal tumor or mass could be cancer, you may be referred to a doctor who specializes in cancer of the reproductive organs, called a gynecologic oncologist.

Because appointments can be brief, it's a good idea to be prepared. The following information can help you get ready for an appointment.

What you can do

• Write down any symptoms you have, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements that you take.
• Consider taking along a family member or friend. Sometimes it can be hard to remember all the information you get during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional.

Questions for your doctor

Below are some basic questions to ask your healthcare professional. If you think of other questions during your appointment, be sure to ask those questions too.

• What's likely causing my symptoms?
• What tests might I need?
• Could my adnexal tumor or mass go away on its own, or will I need treatment?
• Do you have printed materials or brochures I can have? What websites do you recommend?

What to expect from your doctor

Questions your healthcare professional might ask include:

• How often do you have symptoms?
• How bad are your symptoms?
• Do you have regular menstrual cycles?
• What was the date of your last menstrual period?
• Do your symptoms seem to be related to your menstrual cycle?
• Have you used hormonal birth control or infertility medicines? If so, how long did you use them?
• Does anything make your symptoms better?
• Does anything make your symptoms worse?