Adnexal Mass (Tumors)

An adnexal mass (adnexal tumor) is a growth that develops near your uterus, usually in your ovaries, fallopian tubes and neighboring connective tissues. It’s a term your healthcare provider may use to describe various types of masses that develop in your pelvic region.

Some adnexal tumors are fluid-filled, while others are solid. Most adnexal masses aren’t cancerous (benign) and go away on their own within a few months. You can develop an adnexal mass for many reasons.

They’re called adnexal tumors or masses because they appear in the adnexa of your uterus. The term “adnexa” refers to your ovaries, fallopian tubes and ligaments that secure your reproductive organs.

It’s normal to feel panic when your healthcare provider says you have a cyst or mass. But try to relax until your provider can determine what’s causing it. Most adnexal masses aren’t cancerous or life-threatening. Always let your provider know about any unusual symptoms you’re having. This can lead them closer to a diagnosis and treatment, if necessary.

What are the symptoms of adnexal mass?

Not everyone with an adnexal tumor will have symptoms, and your symptoms may vary depending on where the mass is and what’s causing it. Possible symptoms include:

• Pelvic pain
• Difficulty urinating
• Frequent urination
• Irregular menstrual periods
• Bloating
• Constipation
• Pain during sex

What causes adnexal tumors?

Many gynecologic and nongynecologic conditions can cause adnexal masses. Most commonly, the tumors originate in your reproductive organs (gynecologic). But they can also originate in your urinary or digestive systems (nongynecologic).

Gynecologic adnexal tumors

Gynecological causes are the most common type of adnexal mass. A gynecological cause is anything that relates to your reproductive system. There can be many reasons (maybe even hundreds of reasons) you develop an adnexal mass. Some of the more common causes are:

• Ovarian cysts. These fluid-filled cysts form on your ovaries. They’re generally painless and most people never develop symptoms. Ovarian cysts are extremely common.
• Noncancerous ovarian tumors. When abnormal cells grow and multiply in your ovaries, they become solid masses or lumps. Benign (noncancerous) tumors typically don’t spread to nearby tissues or other parts of your body.
• Ectopic pregnancy. If a fertilized egg implants somewhere other than your ovaries, it’s called an ectopic pregnancy. This can cause internal bleeding and severe pain. Left untreated, ectopic pregnancies can be fatal for the birthing mother.
• Corpus luteum cyst. These are harmless, painless cysts that form during ovulation. They resolve on their own after ovulation.
• Polycystic ovary syndrome (PCOS). PCOS is a hormonal condition that can cause small fluid-filled cysts to develop on your ovaries.
• Endometriomas. These are cysts that form on your ovaries that are filled with menstrual blood. They’re typically a sign of endometriosis.
• Hydrosalpinx. This is when your fallopian tube fills with fluid and creates a cyst. These typically don’t cause symptoms but can result in pelvic pain or infertility.
• Tubo-ovarian abscess. Your genital tract can become infected. This can lead to inflammation and pus in your fallopian tube, ovary and surrounding structures.
• Ovarian cancer. When an ovarian tumor is malignant (cancerous), it can grow and spread to other areas of your body.

Nongynecologic adnexal tumors

These masses usually originate in the urinary or digestive systems. These types have nothing to do with your uterus, ovaries or fallopian tubes.

Common types include adnexal masses in your colon, bladder and appendix. It’s also possible for breast cancer and colon cancer to spread (metastasize) to your pelvis, resulting in cancerous adnexal tumors.

What are the risk factors for adnexal tumors?

Anyone with female reproductive organs can get an adnexal tumor or mass. They’re very common, especially if you’re of childbearing age (the time after you get your first period until menopause). This is because many adnexal masses can relate to ovulation.

If you have a history of pelvic inflammatory disease (PID) or endometriosis, you could be more likely to develop an adnexal mass.

How common are adnexal tumors?

In the United States, approximately 1 in 10 women will develop an adnexal mass at some point in their lifetime. Adnexal tumors most commonly occur during the years you’re getting a menstrual period (late teens to 40s), but they can occur at any age.

What are the complications of adnexal tumors?

Most adnexal masses aren’t serious. Only a healthcare provider can determine if a mass is something to worry about. Adnexal masses aren’t typically cancerous and don’t usually long-term or life-threatening complications.

But some causes of adnexal masses do have serious complications. The causes of tumors that do carry risks of serious complications are:

• Ectopic pregnancy
• Cancer
• Any cysts that rupture or leak blood or other fluids
• Adnexal torsion (when your ovary or fallopian tubes twist)

If you have an adnexal mass, symptoms like severe pelvic pain, nausea or vomiting and fever can be signs that you need to contact a healthcare provider right away.

Does having an adnexal mass mean cancer?

No. Most adnexal tumors are benign (noncancerous). But a small percentage are malignant (cancerous). Your risk for having a malignant adnexal tumor increases after menopause.

How are adnexal tumors diagnosed?

Healthcare providers often detect adnexal tumors during a routine pelvic exam. If they suspect a mass, they may order an ultrasound to get a better look at the mass. In some cases, a biopsy or surgery is necessary to determine if the mass contains cancer cells. Your provider may recommend a pregnancy test to rule out ectopic pregnancy.

Once you receive a diagnosis, your healthcare provider may order blood tests and more imaging tests to determine what could be causing the adnexal mass. Other imaging tests that your provider may order include:

• CT scan
• MRI

How is an adnexal mass treated?

Treatment for adnexal masses depends on the specific cause. There are generally three options for treatment:

• No treatment. If the mass is small and painless and your provider is certain it’s not cancerous, they may recommend no further treatment.
• Monitoring. If your provider isn’t entirely sure what’s causing the mass or they have concerns about your symptoms, the size of the mass or the possibility it’s cancer, they may watch the mass over time. Most adnexal masses grow slowly. Monitoring involves follow-up appointments to check on how the mass changes and grows.
• Surgery. If your provider believes the mass is suspicious, or if it’s large and causing you pain, removing the mass is an option. Surgery may be necessary at any time if a mass gets too large, resembles cancer or causes you discomfort. If the mass is an ectopic pregnancy, you may need surgery immediately.

The treatment your provider recommends is unique to you, the type of growth you have and how big it is. Many factors go into determining your treatment plan. Generally, a solid mass is more concerning than a fluid-filled mass. But there are times when a fluid-filled mass is still worrisome. Additionally, masses larger than 6 centimeters (cm) are typically more concerning because they’re more likely to contain cancerous cells. But that doesn’t mean a smaller mass is never cancerous. Because there are so many factors at play, it’s always best to talk to your healthcare provider about your specific situation and treatment plan.

Do adnexal masses need to be removed?

Not always. In many cases, adnexal masses aren’t harmful and will eventually resolve on their own.

What size adnexal cyst needs surgery?

There are several factors your healthcare provider considers when it comes to removing an adnexal cyst. Most adnexal masses don’t grow larger than 3 cm (about the size of a grape). Once a mass reaches 10 cm or larger, your healthcare provider may recommend removing it.

Can adnexal tumors be prevented?

No. You can’t prevent adnexal tumors. But with early detection, you can reduce your risk for complications.

What can I expect if I have an adnexal mass?

If you have an adnexal mass, your healthcare provider will recommend a treatment plan that’s unique to your situation. Oftentimes, adnexal tumors go away on their own without any treatment. Your provider will likely monitor the mass with frequent imaging tests to make sure it doesn’t grow. If your adnexal mass causes painful symptoms, or if it’s concerning for cancer, your healthcare provider will recommend surgical removal.

How serious is an adnexal mass?

Most adnexal tumors aren’t dangerous, and they may even go away on their own over time. In rare instances, the tumor may be cancerous. Only a healthcare provider can determine if the mass is serious or life-threatening (like with an ectopic pregnancy or cancer). Try not to panic until you know what kind of adnexal mass you have.

If you experience intense pelvic pain, fever or vomiting, then you should seek immediate medical attention, as these symptoms could be a sign of a medical emergency.

When should I see my healthcare provider?

If your healthcare provider diagnoses you with a benign adnexal tumor, be sure to follow their treatment plan and attend any follow-up appointments. During these visits, they’ll check to see if the tumor has grown.

You should also call your provider any time you develop painful or uncomfortable symptoms. These changes could mean the mass is growing.

What questions should I ask my healthcare provider?

Some questions to ask your provider include:

• Will I need surgery?
• How often will you monitor the mass?
• Is there any chance the mass is cancerous?
• What symptoms mean something is wrong?