Management of ovarian cysts in postmenopausal women

Management of ovarian cysts in postmenopausal women By El-Said Abdel-Hady, PhD MRCOG , Mansoura University .

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Suspicious findings on USS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RISK OF MALIGNANCY INDEX (RMI) Jacobs et al Br J O bstet Gynaecol 1990 : 97 : 922-9 Score Scoring System Criteria A (1 or 3) 1 3 Menopausal status premenopausal postmenopausal B (0,1 or 3) No feature = 0 One feature =1 > 1 feature =3 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],C Absolute level Serum CA 125 Ax B x C RISK OF MALIGNANCY INDEX

RISK OF MALIGNANCY INDEX (RMI) ,[object Object],[object Object],[object Object]

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Flowchart for the management of ovarian cysts in postmenopausal women TVS and Serum CA125 Calculate RMI RMI <25 RMI 25 - 250 RMI >250 Laparoscopy or laparotomy in cancer unit Can be managed by a general gynecologist laparotomy in cancer center RCOG Guideline No. 34 October 2003

Simple unilateral cyst < 5 Serum CA125 < 30 Other cysts Conservative management Normally Laparoscopy Repeat TVS + CA125 (for max. of one year at / 4 months Cyst resolved or reduced in size No change in cyst Cyst increased in size or developed suspicious features Discharge If no changes after one year ( three scans) then discharge RMI <25 Can be managed by a general gynecologist Calculate RMI& Manage As above RCOG Guideline 2003

Management options ,[object Object],[object Object],[object Object],[object Object]

Conservative management ,[object Object],[object Object],[object Object]

LOW RISK:( RMI <25): < 3% risk of cancer ,[object Object],[object Object],[object Object]

MODERATE RISK: RMI =25-250 approximately 20% risk of cancer ,[object Object],[object Object],[object Object]

HIGH RISK: RMI =>250 > 75% risk of cancer ,[object Object],[object Object]

What is the role of aspiration in the management of postmenopausal ovarian cysts? ,[object Object],[object Object]

Aspiration has no place ,[object Object],[object Object]

Laparoscopy ,[object Object],[object Object]

Laparoscopy showing ovarian malignancy

Laparotomy ,[object Object],[object Object]

Laparotomy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Management of ovarian cysts in postmenopausal women

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Management of ovarian cysts in postmenopausal women