Pelvic Mass

A "mass" is a lump that either your caregiver found during an examination or you found before seeing your caregiver. The "pelvis" is the lower portion of the trunk in between the hip bones. There are many possible reasons why a lump has appeared. Testing will help determine the cause and the steps to a solution.

CAUSES

Before complete testing is done, it may be difficult or impossible for your caregiver to know if the lump is truly in one of the pelvic organs (such as the uterus or ovaries) or is coming from one of many organs that are near the pelvis. Problems in the colon or kidney can also lead to a lump that might seem to be in the pelvis.

If testing shows that the mass is in the pelvis, there are still many possible causes:

  • Tumors and cancers. These problems are relatively common and are the greatest source of worry for patients. Cancerous lumps in the pelvis may be due to cancers that started in the uterus or ovaries or due to cancers that started in other areas and then spread to the pelvis. Many cancers are very treatable when found early.

  • Non-cancerous tumors and masses. There are a large number of common and uncommon non-cancerous problems that can lead to a mass in the pelvis. Two very common ones are fibroids of the uterus and ovarian cysts. Before testing and/or surgery, it may be impossible to tell the difference between these problems and a cancer.

  • Infection. Certain types of infections can produce a mass in the pelvis. The infection might be caused by bacteria. If there is an infection treatment might include antibiotics. Masses from infection can also be caused by certain viruses, and in rare cases, by fungi or parasites. If infection is the cause, your caregiver will be able to determine the type of germ responsible for the mass by doing appropriate testing.

  • Inflammatory bowel disease. These are diseases thought to be caused by a defect in the immune system of the intestine. There are two inflammatory bowel diseases: Ulcerative Colitis and Crohn's Disease. They are lifelong problems with symptoms that can come and go. Sometimes, patients with these diseases will develop a mass in the lower part of the colon that can make it seem as though there is a mass in the pelvis.

  • Past Surgery. If there has been pelvic surgery in the past, and there is a lot of scarring that forms during the process of healing, this can eventually fell like a mass when examined by your caregiver. As with the other problems described above, this may or may not be associated with symptoms or feeling badly.

  • Ectopic Pregnancy. This is a condition where the growing fetus is growing outside of the uterus. This is a common cause for a pelvic mass and may become a serious or life-threatening problem that requires immediate surgery.

SYMPTOMS

In people with a pelvic mass, there may be a large variety of associated symptoms including:

  • No symptoms, other than the appearance of the mass itself.

  • Cramping, nausea, diarrhea.

  • Fever, vomiting, weakness.

  • Pelvic, side, and/or back pain.

  • Weight loss.

  • Constipation.

  • Problems with vaginal bleeding. This can be very variable. Bleeding might be very light or very heavy. Bleeding may be mixed with large clots. Menstruation may be very frequent and may seem to almost completely stop. There may be varying levels of pain with menstruation.

  • Urinary symptoms including frequent urination, inability to empty the bladder completely, or urinating very small amounts.

DIAGNOSIS

Because of the large number of causes of a mass in the pelvis, your caregiver will ask you to undergo testing in order to get a clear diagnosis in a timely manner. The tests might include some or all of the following:

  • Blood tests such as a blood count, measurement of common minerals in the blood, kidney/liver/pancreas function, pregnancy test, and others.

  • X-rays. Plain x-rays and special x-rays may be requested except if you are pregnant.

  • Ultrasound. This is a test that uses sound waves to "paint a picture" of the mass. The type of "sound picture" that is seen can help to narrow the diagnosis.

  • CAT scan and MRI imaging. Each can provide additional information as to the different characteristics of the mass and can help to develop a final plan for diagnostics and treatment. If cancer is suspected, these special tests can also help to show any spread of the cancer to other parts of the body. It is possible that these tests may not be ordered if you are pregnant.

  • Laparoscopy. This is a special exam of the inside of the pelvic area using a slim, flexible, lighted tube. This allows your caregiver to get a direct look at the mass. Sometimes, this allows getting a very small piece of the mass (a biopsy). This piece of tissue can then be examined in a lab that will frequently lead to a clear diagnosis. In some cases, your caregiver can use a laparoscope to completely remove the mass after it has been examined.

  • Surgery. Sometimes, a diagnosis can only be made by carrying out an operation and obtaining a biopsy (as noted above). Many times, the biopsy is obtained and the mass is removed during the same operation.

These are the most common ways for determining the exact cause of the mass. Your caregiver may recommend other tests that are not listed here.

TREATMENT

Treatment(s) can only be recommended after a diagnosis is made. Your caregiver will discuss your test results with you, the meanings of the tests, and the recommended steps to begin treatment. He/she will also recommend whether you need to be examined by specialists as you go through the steps of diagnosis and a treatment plan is developed.

HOME CARE INSTRUCTIONS

  • Test preparation. Carefully follow instructions when preparing for certain tests. This may involve many things such as:

  • Drinking fluids to fill the bladder before a pelvic ultrasound.

  • Fasting before certain blood tests.

  • Drinking special "contrast" fluids that are necessary for obtaining the best CAT scan and MRI images.

  • Medications. Your caregiver may prescribe medications to help relieve symptoms while you undergo testing. It is important that your current medications (prescription, non-prescription, herbal, vitamins, etc.) be kept in mind when new prescriptions are recommended.

  • Diet. There may be a need for changes in diet in order to help with symptom relief while testing is being done. If this applies to you, your caregiver will discuss these changes with you.

SEEK MEDICAL CARE IF:

  • You cannot hold down any of the recommended fluids used to prepare for tests such as CAT scan MRI.

  • You feel that you are having trouble with any new prescriptions.

  • You develop new symptoms of pain, vomiting, diarrhea, fever, or other problems that you did not feel since your last exam.

  • You experience inability to empty your bladder completely or develop painful and/or bloody urination.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You vomit bright red blood, or a coffee ground appearing material.

  • You have blood in your stools, or the stools turn black and tarry.

  • You have an abnormal or increased amount of vaginal bleeding.

  • You have a fever.

  • You develop easy bruising or bleeding.

  • You develop pain that is not controlled by your medication.

  • You feel worsening weakness or you have a fainting episode.

  • You feel that the mass has suddenly gotten larger.

  • You develop severe bloating in the abdomen and/or pelvis.

  • You cannot pass any urine.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.