Adnexal Tumors - Causes, Types, Symptoms, and Treatment

What Are Adnexal Tumors?

Adnexal tumors (also known as adnexal masses) are the growth of cells originating from reproductive organs or pelvic organs (like intestines or urinary bladder). Adnexal tumors can grow on the uterus or surrounding organs like connective tissues, ovaries, or fallopian tubules. Most adnexal tumors are benign (non-cancerous), but they can be malignant (cancerous) too. These tumors can appear at any age and mostly go away by themselves in a few months to years.

Are Uterine Polyps and Adnexal Tumors the Same?

Although both the conditions: uterine polyps and adnexal tumors, show similar symptoms, they are entirely different conditions.

• Uterine Polyps - These are the growth of cells on the inner lining (endometrium) of the uterus.

• Adnexal Tumors - These are the growth of cells around the uterus, including ovaries and fallopian tubes.

What Are the Causes of Adnexal Tumors?

Adnexal masses are the abnormal growth of cells due to gynecological or non-gynecological reasons. They commonly develop from the female reproductive system, but sometimes they can also originate from the urinary or digestive systems.

Does Adnexal Tumor Mean Cancer?

Adnexal tumors are not always cancer. In fact, most of the adnexal masses are benign, and do not need any treatment. But sometimes, they can be malignant (cancerous). Postmenopausal women and prepubertal girls are at a higher risk of developing malignancy as compared to premenopausal women.

What Are the Different Types of Adnexal Tumors?

Adnexal tumors are classified based on their location and potential of being cancerous or non-cancerous.

They are as follows,

Gynecologic Adnexal Tumors - Tumors that grow in and around the organs of female reproductive organs.

These are further classified as follows,

1. Benign Ovarian - These adnexal masses are present as functional cysts (abnormally grown cells filled with fluids) or tumors (abnormally developed solid masses of cells that have no purpose). They are non-cancerous and present with no symptoms. No treatment is needed for this type of mass as they are not harmful and usually go away by themselves. However, cysts might grow in size and rupture in some cases, causing pain and internal bleeding.

2. Malignant Ovarian - These are rare ovarian cancers. It is not easy to diagnose these in the initial stages, thus are mostly diagnosed in advanced stages. Malignant tumor cells can grow in the epithelium, egg cells, or the connective tissues of the ovary.

3. Benign Nonovarian - These are non-cancerous adnexal masses present outside the ovaries. Examples-

• Ectopic Pregnancy - the fertilized egg grows outside the uterus.

• Hydrosalpinx - blockage of the fallopian tube by watery fluid.

• Endometrioma - cystic lesions in the ovaries.

• Leiomyoma - tumors in the uterine wall.

• Tubo-ovarian Abscess (TOA) - the infectious mass of cells formed due to infection in the ovary or fallopian tubule.

4. Malignant Nonovarian - This type of adnexal mass is cancerous. These masses grow outside the ovaries. Examples-

• Endometrial Carcinoma - cancer of the uterine lining.

• Fallopian Tube Carcinoma - cancer of fallopian tubules.

Nongynecologic Adnexal Tumors- Sometimes, adnexal masses can grow outside the reproductive organs (ovaries, fallopian tubules, uterus, or connective tissues). Examples-

• Appendicitis (inflammation of the appendix).

• Pelvic kidney (kidney located in the pelvis instead of the abdomen).

• Bladder diverticulum (pouch in the bladder wall)- this condition can be congenital (by birth) or acquired.

• Gastrointestinal tract cancer (cancer of digestive tract organs like stomach, pancreas, colon, small and large intestines, rectum, anus, liver, or biliary system).

• Nerve sheath tumor (cancer of nerve cells lining).

• Malignant adnexal tumors can also be formed due to metastasis (spread) of breast cancer and colon cancer to the pelvis.

What Are the Symptoms of Adnexal Tumors?

Symptoms may differ depending on the cause and type of adnexal tumors. Some common symptoms are-

• Pelvic pain.

• Unusual vaginal bleeding.

• Changes in menstruation.

• Bloating.

• Strong desire to urinate.

• Dyspareunia (genital pain during sexual intercourse).

How Are Adnexal Tumors Diagnosed?

A detailed medical, gynecologic and familial history is recorded, followed by a pelvic examination.

The following measures can help to diagnose the adnexal masses-

• Blood tests are done to check for elevated serum levels and to check for sexually transmitted infections like gonorrhea or chlamydia.

• Pregnancy test for women of childbearing age.

• Transvaginal ultrasonography.

• Computed tomography (CT).

• Magnetic resonance imaging (MRI).

• Biopsy for cancer diagnosis.

What Are the Treatment Options for Adnexal Tumors?

Treatment for adnexal tumors depends on the location of the adnexal mass and the cause of this cell growth.

The three main options for the treatment of adnexal tumors include-

1. Expectant Management - Benign adnexal tumors or cysts with no symptoms are left untreated. They generally go away by themselves. Periodic tests are performed to keep a check on the situation.

2. Continued Surveillance - For doubtful cases where the adnexal mass looks benign but might turn cancerous in the future. Follow-up ultrasound and blood tests are performed repeatedly.

3. Surgery - Surgical intervention is needed when the tumor grows too big, causing pain, internal bleeding, or malignancies (cancer).

   • Adnexal masses can be removed using laparoscopy with minimum postoperative complexity.

   • Women with preexisting medical problems or cancer need preoperative evaluation to avoid complications.

   • Women with medical risk factors for surgery need to consider nonsurgical management and follow-up care.

4. Additional Therapies - Malignant cases may need additional therapies like chemotherapy and radiotherapy combined with medical and surgical treatments for better results.

How to Prevent Adnexal Tumors?

Adnexal tumors can not be prevented, but an early diagnosis can help avoid complications. Medications can be taken to prevent the recurrence of adnexal tumors.

Conclusion:

Adnexal tumors or adnexal masses are the abnormal growth of cells occurring commonly among females of all ages. Mostly these tumors are benign, self-limiting, and resolve on their own, but sometimes they can turn cancerous. They tend to recur, so regular checkups, tests, and medication are vital for women at risk. Early diagnosis and treatment are the essential keys to a successful treatment.