Finally, important points for the management and treatment of patients with tumor adnexal actions: 1 the choice between surgery or conservative (that is, surveillance) depends on symptoms and the age of the woman. It is not the same to want to include a 16 or 18 year old patient as a 43 or 44 year old patient because the stages of life can suggest to us if there is a mismatch between the beginning of menstruation and this prepubertal or pubertal or adolescent woman is having those endocrine changes and they are functional cysts, in a 42-year-old woman, as we have seen, that age and then comes with large tumors and it is mixed, so there the suspicion is greater.
The time of evolution and the anamnesis are of utmost importance. When did your pain start? How did it start? Has it been increasing or is it just a nuisance? Because on many occasions they operate on them and say “It’s an emergency” and the patient really had a small, dull pain, because it had not increased in two or three days and it is still present, well that is not an ovarian torsion and that It is surely not a tumor that has to be operated on in an emergency. The only emergency of an adnexal tumor is an acute abdomen. Important Why? Because a patient may come to me with a hemorrhagic cyst, with moderately intense pain and say “It was sudden, it’s hurting, it twists me.” But you do the examination, you touch him, if there is a little resistance, you do an ultrasound, no. There is free fluid, there is not so much pain on pressure and you see that tumor, so many times it is even not giving painkillers but rather monitoring and saying: Let’s see, let’s wait a day or two and see if the pain decreases or disappears, Because it is true that hemorrhagic cysts are one of the most urgently operated surgeries because of course, they begin to fill with blood, it hurts a lot and is often confused with even mixed tumors or high-risk tumors and it is sometimes not necessary to remove them. Well, a hemorrhagic cyst because that is going to be reabsorbed.
Endometriotic cysts can also cause acute abdomen when that capsule ruptures and that tissue that we have already talked about endometriosis is secreted, yes, since that matter that is secreted is very toxic or is very chemical, it irritates the peritoneum and gives an acute abdomen, We would have to go in there… But be careful! The vast majority of adnexal tumor emergencies should not necessarily have been surgical. Priority in most cases is only cystectomy, that is, even if it is an emergency surgery, preferably having an ultrasound before to see the lesion, and what we can do whether laparoscopic or open is to incise the cortex of the ovary, puncture The cyst was scheduled to see if it is hemorrhagic and if not, if we suspect that it is malignant, then we cannot puncture it, but the most important thing is to try to only remove that tumor and preserve the ovary.
The management of benign ovarian adnexal tumors is very different than that of malignant tumors. I am not going to talk about malignant cancers, but I do want you to know that as I mentioned, the possibility of ovarian cancer is very small in the standard or average population, which is from 12 years old to 45 or 50, and above 50 years old. The risk of ovarian cancer can be further increased. The indication for Oopherectomy must be well evaluated, the only indication to remove the ovary as I had told you is a twisted cyst, if you see the ovary already necrotic, it will look dark or bruised and it no longer makes any sense to leave it, because there Yes we cannot preserve that ovary, but the most important thing is: If it is an acute abdomen then you only have to go to a hospital there if a doctor cannot see you in consultation and if it is not an acute abdomen go to an obstetrician-gynecologist and secondly ask a second opinion if you have doubts about whether to have surgery or not because it is very important to try to preserve the two gonads, that is, the two ovaries as much as possible so as not to have infertility repercussions later.