The etiology of adnexal masses ranges from physiologically normal luteal cysts to ovarian cancer. If an adnexal mass larger than 6 cm is found on ultrasonography, or if findings persist longer than 12 weeks, referral to a gynecologist or gynecologic oncologist is indicated.

Serial ultrasonography and periodic measurement of CA 125 levels may help in differentiating between benign or potentially malignant adnexal masses. If disease is suspected outside of the ovary, computed tomography may be indicated magnetic resonance imaging may better show malignant characteristics in the ovary. Large mass size, complexity, projections, septation, irregularity, or bilaterality may indicate cancer. Transvaginal ultrasonography is the first choice for imaging of an adnexal mass. Because substantial overlap in CA 125 levels between pre- and postmenopausal women may occur, this level alone is not recommended for differentiating between a benign and a malignant adnexal mass. CA 125 levels are elevated in conditions other than ovarian cancer. A cancer antigen 125 (CA 125) test may assist in the evaluation of an adnexal mass in appropriate patients. Ectopic pregnancy must be ruled out in women of reproductive age. Pelvic examination has low sensitivity for detecting an adnexal mass negative pelvic examination findings in a symptomatic woman should not deter further workup. Women who report abdominal or pelvic pain, increased abdominal size or bloating, difficulty eating, or rapid satiety that occurs more than 12 times per month in less than a year should be evaluated for ovarian cancer. Adnexal masses can have gynecologic or nongynecologic etiologies, ranging from normal luteal cysts to ovarian cancer to bowel abscesses.

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