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Case History : Management of ovarian tumor review

This patient is not obese.

Pelvic mass
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Pelvic mass. Pelvic masses may present with abdominal distention from the mass, ascities, or both.
Credits: C. Matthew Peterson, M.D.

Abdominal distension may be due to ascites or a mass, or both. A large ovarian neoplasm is a common cause of abdominal distention in some age groups (less than 20 years and postmenopausal). A neglected mucinous cystadenoma may become extremely large--several hundred pounds.

Mucinous Cystadenoma
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Mucinous Cystadenoma. Neglected mucinous cystadenoma may become extremely large.
Credits: C.Matthew Peterson, M.D.

This ultrasound study demonstrates a large cystic ovarian mass.

Ovarian cyst demonstrated by ultrasound
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Ovarian cyst demonstrated by ultrasound. The ovarian cyst fills the abdominal cavity in this sagittal view and is seen overlying the uterus. The bladder is represented by Bl.
Credits: C. Matthew Peterson, M.D.

An ovarian mass may move into an abdominal position because it is too large to fit into the hollow of the pelvis. When planning for the surgical removal of an ovarian mass it is assumed it is cancer until it is fully evaluated.

Surgery for a supposed benign cyst is not technically difficult. A large vertical incision is required. It is important not to rupture the mass. Abdominal and pelvic washings for cytology and a frozen section are evaluated by the pathologist to rule out malignancy.

Ovarian tumor
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Ovarian tumor. A large vertical incision allows delivery and excision of an ovarian neoplasm. Pelvic washings for cytology and a frozen section rule out a malignancy. The cyst is excised carefully to avoid spilling contents into the abdomen.
Credits: C. Matthew Peterson, M.D.

The cyst, which is part of the ovarian cortex, is excised carefully. Once it is confirmed to be benign the remaining ovary may be retained. If it demonstrates malignancy or a low malignant potential a gynecologic oncologist should be consulted for complete staging and therapy which may include a total abdominal hysterectomy, lymph node sampling, omentectomy, appendectomy and multiple biopsies. Screening for ovarian malignancy is not ideal. Some cases are detected fortuitously with the pelvic examination for a routine pap smear. Routine ultrasound screening of the general population for ovarian malignancy is expensive, and not adequately sensitive or specific for early ovarian cancer. CA 125 is an ovarian tumor marker that also has not demonstrated adequate sensitivity or specificity.

Ovarian cancer occurs more frequently with advancing age, as follows:

20-44 years 7/100,000
45-64 years 27/100,000
65-74 years 70/100,000
over 75 years 145/100,000

To review risk factors for ovarian cancer are as follows:

  • Infertility
  • Low parity
  • Use of perineal talc
  • High fat diets
  • Lactose intolerance
  • Previous breast or colon cancer
  • A family history of ovarian cancer

Symptoms of ovarian malignancy generally do not appear until later stages of the disease. Patients eventually develop abdominal distension from tumor mass and ascites. A pelvic mass can also present with complaints of chronic pelvic pain and pelvic pressure. in cases of advanced metastasis patients, weight loss and bowel obstruction are frequently noted. All postmenopausal women should be screened for symptoms of this cancer and their family histories evaluated to detect a high risk status.