Your second patient is a 49 year old G4P4 with menopausal symptoms, indigestion, constipation, weight loss and is found to have and irregular mass that fills the pelvis. You should:
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This patient has an ovarian cancer until proven otherwise. Initial diagnosis at a late stage with a mass filling the pelvis is not unusual.
Credits: C. Matthew Peterson, M.D.
Other considerations would include adnexal spread of endometrial cancer, colon cancer, or possibly an inflammatory mass associated with the bowel. Benign entities like a fibroid uterus may also be possible but are inconsistent with this patient's presentation. This patient is a candidate for surgical exploration, and tumor debulking. The surgical specimen is likely to include the uterus, tubes, ovaries, omentum, and possibly a portion of the bowel and lymph node sampling. Colostomy is a possibility. The urinary system also may be involved. A bowel prep is appropriate prior to surgery, which will be performed through a vertical incision. Ovarian epithelial carcinoma has a relatively high response rate. Generally, cis-platinum is used in six cycles of therapy. Maximum tumor debulking at surgery is critical. Despite these aggressive measures, relapses are routine.