Surgery for Adnexal Masses
Whether surgery is the right choice for an adnexal mass depends on a number of things:
- the risk of malignancy
- how you feel about the possibility of infertility
- the size of the tumor
- how it looks on ultrasound
- past surgeries you’ve had
- how bad the symptoms are
If the mass does not appear suspicious and the CA 125 is normal, you might not need surgery. All that might be needed is to follow the mass with future exams and sonograms.
A doctor may choose to manage a mass that does not seem suspicious with laparoscopy. To do this, the doctor will make several small incisions, including one in the belly button. The doctor will then insert a viewing scope, which is a narrow camera, and surgical instruments through these cuts. The doctor will use a video screen to view the surgery. Sometimes, the instruments are held by a surgical robot. This is called robotic surgery. These methods can be used to remove the entire ovary. In some cases, just the ovarian cyst will be removed.
A specialist in these procedures may choose to operate on suspicious adnexal masses this way. If there is a very high risk of the mass being cancerous, surgery will most likely be done through a larger incision in the abdomen.
A gynecologic oncologist performs surgery on suspicious ovarian masses. Usually, a skin incision, or cut, is made. Then the ovary or the cyst is removed. Another doctor then examines the cyst or ovary under a microscope. This doctor is a pathologist. He or she will check to see if the cyst or ovary is benign. If it is, that means it’s not cancerous. If it is cancerous, it is said to be malignant.
If the mass is benign, there are a number of options. In young women, it is often possible to remove only the ovarian cyst and to save the remainder of the ovary. In other situations, it is better to remove both ovaries and perform a complete hysterectomy. That means removal of the uterus and cervix. This might be a good option if you do not wish to stay fertile and are close to menopause. It might also be a good option if you have other gynecologic problems that need to be managed by surgery. These problems might include uterine fibroids or abnormal bleeding.
If your ovaries and uterus need to be removed, your doctor should talk to you about it before surgery. This type of surgery should only be done when the benefit outweighs the risks, pain, and inconveniences.
If the biopsy is positive for cancer, it’s possible the tumor may not seem to be spreading. In that case, the surgeon will do a surgical staging procedure. The surgeon will examine the upper abdomen and biopsy the lymph nodes. The surgeon will also remove the omentum. That’s a layer of fatty tissue in the upper abdomen. The surgeon will do other biopsies that will show if the cancer has spread. Usually, if ovarian cancer is found, the surgeon will remove the ovaries, the fallopian tubes, and the uterus. In young women who want to be able to have children, the surgeon will sometimes only remove the ovary and tube that has the cancer.
An advanced cancer is one that has already spread. Cancers that have spread are said to have metastasized. If one of these cancers is found, the surgeon usually removes both ovaries. The surgeon will also perform a hysterectomy, removing the uterus and cervix. Then the surgeon will remove other areas of cancer spread as completely as possible. For more information about ovarian cancer treatment and surgery, click here.