Ovarian Neoplasms

Clinical Case:

A 48 year old G3P3 woman comes to the office for a health maintenance exam. She has no concerns. She is in good health. She had three normal vaginal deliveries and underwent a tubal ligation after the birth of her third child 15 years ago. She has no history of abnormal Pap smears or sexually transmitted diseases. Her cycles are regular and her last menstrual period was 18 days ago. She is not taking any medications. Her family history is significant for a maternal aunt who was diagnosed with ovarian cancer at age 60. On examination, she has normal vital signs. Her heart, lungs and abdominal exams are normal. On pelvic examination, she has normal external genitalia, normal vagina and cervix. On bimanual exam, she has a slightly enlarged uterus and a palpable right adnexal mass which is confirmed on the vagino-rectal exam.

Discussion questions:

  1. What is the next step in the management of this patient?
  2. How would your approach be different if the patient was postmenopausal at 62 years of age?
  3. You obtain an ultrasound which shows a 6 cm right complex ovarian cyst. What is your differential diagnosis?
  4. What risk factors does this patient have for ovarian cancer?
  5. List physical exam elements which help support or rule out the diagnosis of ovarian cancer.
  6. Assuming the mass is persistent and you need to surgically explore the patient, describe the pre-operative, intra-operative and post-operative management of this patient.


  1. Obstetrics and Gynecology by Beckmann 5 th Edition, 2006; Chapter 47 Ovarian and Adnexal Masses. Pages 464-476.
  2. Essentials of Obstetrics and Gynecology by Hacker and Moore 4 th Edition, 2004; Chapter 40 Ovarian Cancer. Pages 459-468.

Adnexal masses are a common finding in both symptomatic and asymptomatic patients. Management is based on determining the origin and character of these masses.

The APGO Educational Objectives related to this topic are the following:

  1. Outline the approach to a patient with an adnexal mass *
  2. Compare the characteristics of functional cysts, benign ovarian neoplasm and ovarian malignancies *
  3. Describe the symptoms and physical findings of a patient with ovarian malignancy *
  4. List the risk factors for ovarian cancer *
  5. Describe the histological classification of ovarian neoplasm
  6. Counsel a woman with risk for ovarian cancer *

*Designated as Priority One in the APGO Medical Student Educational Objectives, 8 th Edition

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