Management of Pelvic Masses

The female pelvis is actually designed to accommodate some fairly large objects (e.g. pregnant uterus). A mass in the female pelvis can actually get to be about the size of a soccer ball before many women (even very thin women) will notice anything. As a mass enlarges it usually will rise out of the pelvis and into the lower part of the abdomen. Because of this organs in the pelvis like the bladder and rectum are not usually affected by an enlarging pelvic mass.

Only a pathologist can answer this question by looking at the mass under a microscope once it is removed. There is no magical test that can prove or disprove that your mass is a malignancy until this is done. Because of this we do not customarily get a lot of pre-operative tests (e.g. CT scans,  ultrasound exams) when you come to us with a pelvic mass. No matter what pre-operative tests  reveal you will still require surgical removal of your mass and a pathologist will still have to evaluate the tissue microscopically. 

In most cases we will have the pathologist do a quick evaluation of your mass right at the time of surgery (frozen section). Although a frozen section lacks detail it is generally sufficient for us to determine whether we are dealing with a cancer at the time of the surgery.

Sometimes. 

If you have a small physiologic cyst, endometrioma or cystic teratoma it sometimes possible to salvage a portion of the ovary. Benign tumors do not generally grow off the surface of the ovary as they enlarge. Instead they tend to incorporate the ovary with them as they enlarge. As all benign tumors enlarge the amount of normal identifiable ovarian tissue becomes minimal and sometimes impossible to locate. In these situations removal of the entire ovary is the only way to assure that all of the benign tumor is resected.

Proper surgical technique includes removal of diseased organs and/or restoration of normal anatomy. Removal of normal functioning organs is usually not appropriate. If you are pre-menopausal there is rarely an indication for removal of a normal ovary and/or uterus. If you are post-menopausal then removal of the non-functioning contralateral ovary and uterus is optional.