Postmenopausal patient with an adnexal mass on imaging

This algorithm pertains to average-risk patients. Patients with a hereditary ovarian cancer syndrome (eg, BRCA mutation, Lynch syndrome) are managed differently; for more information, refer to UpToDate content on hereditary ovarian cancer syndromes.
Imaging typically includes pelvic ultrasound (transvaginal and transabdominal); for masses with an indeterminant appearance on ultrasound, MRI may be used as a secondary imaging study, or the patient may be referred to an ultrasound specialist.
The O-RADS classification system is detailed separately in related UpToDate topics.

O-RADS: Ovarian-Adnexal Reporting and Data System; CA 125: cancer antigen 125; BRCA: breast cancer susceptibility genes; MRI: magnetic resonance imaging; HE4: human epididymis protein 4; CEA: carcinoembryonic antigen; CA 19-9: cancer antigen 19-9.
* Other tumor markers may include (but are not limited to) HE4, CEA, or CA 19-9.
¶ We also proceed with surgical management for patients with a mass between 5 and 10 cm diameter if they also have clinically significant symptoms.
Δ Surgical management includes, at a minimum, unilateral salpingo-oophorectomy; a staging procedure is performed if malignancy is found.
◊ Tumor markers (eg, CA 125) are typically obtained preoperatively to help guide management.
§ Ovarian cancer symptoms and risk factors are discussed in detail in related UpToDate topics.
¥ Surgical management may be performed in patients who desire removal of the mass, even in the absence of findings or symptoms suggestive of malignancy.

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Postmenopausal patient with an adnexal mass on imaging