Snapshot A 70-year-old woman presents with lower extremity edema and early satiety. She also reports pelvic discomfort. She underwent menopause at 50 years of age. Pelvic examination is notable for an adnexal mass. CA-125 levels are noted to be elevated with transvaginal ultrasound demonstrating an ovarian mass concerning for malignancy. Introduction Overview malignant neoplasm originating from the ovaries Epidemiology incidence second most common gynecologic malignancy most common gynecologic malignancy that results in death risk factors BReast CAncer gene (BRCA) 1 (chromosome 17) or 2 (chromosome 13) mutation early menarche family history nulliparity infertility endometriosis polycystic ovarian syndrome hereditary nonpolyposis colorectal cancer (HNPCC) syndrome login to view 1 more bullet protective factors breast feeding login to view 1 more bullet oral contraceptive pills chronic anovulation Associated conditions BRCA 1 or 2 mutations Lynch syndrome Presentation Symptoms asymptomatic (in early stages of the disease) pelvic and/or abdominal pain bloating urinary urgency or frequency vaginal bleeding Physical exam adnexal mass highly concerning in postmenopausal women since their ovaries should be atrophic Imaging Pelvic ultrasound (e.g., transvaginal or transabdominal ultrasound) indication imaging study of choice login to view 4 more bullets findings ovarian mass; however, its not specific for ovarian cancer login to view 4 more bullets Studies Serum labs CA-125 (cancer antigen 125) sensitivity and specificity for ovarian cancer is highest in postmenopausal women with a pelvic mass note that other conditions can increase CA-125 levels login to view 3 more bullets Histology indication to confirm the diagnosis and specific the ovarian tumor subtype login to view 1 more bullet ovarian tumor subtypes surface epithelium tumors login to view 16 more bullets germ cell tumors login to view 16 more bullets sex cord stromal tumor login to view 12 more bullets other login to view 8 more bullets Differential Leiomyoma differentiating factors whorled pattern of smooth muscle in the uterus Treatment Ovarian cancer treatment depends on the stage, nodal status, and pathology e.g., bilateral salpingo oopherectomy Complications Ascites Malignant pleural effusion Bowel obstruction Metastasis