A pelvic mass is a general medical finding describing any unusual growth or swelling located in the lower abdomen or pelvis. This descriptive term refers to a lump or enlargement detected during a physical exam or imaging test. It is intentionally broad, encompassing a wide range of underlying conditions that require further investigation to determine their exact nature and whether they are malignant.
Defining a Pelvic Mass
The pelvis is the lower section of the trunk, containing the reproductive organs, bladder, and rectum. A mass is simply an abnormal collection of tissue that occupies space within this region. Pelvic masses are differentiated primarily by their internal structure, which is visualized through imaging.
Masses are distinguished as cystic or solid. Cystic masses are fluid-filled sacs, while solid masses are composed primarily of dense tissue, such as a tumor or a fibroid. Many masses are complex, containing both fluid-filled and solid components, which often prompts closer scrutiny. The specific medical diagnosis is revealed through subsequent workup.
Common Causes and Classifications
Pelvic masses are categorized based on the organ system from which they arise. The most frequent sources are gynecological organs, including the uterus, ovaries, and fallopian tubes. Uterine fibroids, which are non-cancerous, solid tumors of the muscular wall, are a common cause. These fibroids can significantly enlarge the uterus, presenting as a mass.
Ovarian masses are frequent and range from functional cysts, which typically resolve on their own, to benign or malignant tumors. Endometriomas, or “chocolate cysts,” are ovarian masses caused by endometrial tissue growing on the ovary. Pathological conditions of the fallopian tubes, such as hydrosalpinx (a fluid-filled tube) or tubo-ovarian abscesses, also present as gynecological masses.
Non-gynecological pelvic masses originate from adjacent structures, including the bowel, bladder, or musculoskeletal system. Examples include a pelvic kidney, masses arising from the intestines (such as abscesses or primary colorectal tumors), or, rarely, metastasis from a distant malignancy. Patient age is a factor, as masses in postmenopausal women have a higher potential for malignancy than those in younger women.
Recognizable Symptoms
Many pelvic masses are asymptomatic and found incidentally during routine physical or imaging exams. When symptoms occur, they are often non-specific. A frequent complaint is pelvic pain, which can manifest as a dull, chronic ache or sudden, severe pain if the mass ruptures or causes complications like adnexal torsion.
Patients may experience a sensation of pressure or fullness in the lower abdomen due to the mass pushing on surrounding organs. Changes in bowel or bladder habits are common, resulting in frequent urination, difficulty emptying the bladder, or constipation. For women, symptoms can include abnormal uterine bleeding, such as heavy or irregular menstruation, or bleeding between periods or after menopause.
Diagnostic Procedures
Identifying a pelvic mass begins with a thorough medical history and a physical examination, including a comprehensive pelvic exam. This initial assessment allows the healthcare provider to feel for any abnormal size, shape, or mobility of the pelvic organs. Imaging studies are then used to confirm the mass’s presence and gather specific details.
Transvaginal ultrasound is typically the first-line imaging modality due to its availability and effectiveness. If ultrasound results are inconclusive or the mass is complex, further imaging with a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) may be used. MRI is valuable for characterizing benign masses and determining the organ of origin. Laboratory tests often include a serum CA-125 measurement, a blood marker that can be elevated in ovarian cancer or numerous benign conditions. A definitive diagnosis, especially for suspicious masses, often requires a biopsy or surgical exploration for tissue examination.
General Treatment Approaches
The management of a pelvic mass is personalized based on its nature, the patient’s age, and symptom severity. For many small, simple, and asymptomatic masses, such as functional ovarian cysts in younger women, observation and monitoring are appropriate. These masses often resolve on their own within a few menstrual cycles, using follow-up imaging to ensure stability or disappearance.
Medical management may involve hormonal contraceptives to prevent new functional cysts. For uterine fibroids, medications can manage symptoms or attempt to shrink the mass. Surgical intervention is necessary if a mass is large, causes persistent symptoms, grows rapidly, or suggests malignancy. Surgical options range from minimally invasive procedures, such as laparoscopy, to more extensive open surgery for suspected cancerous masses.