Chapter 20 - Pelvic Mass and Ovarian Cancer

Summary

Masses of the ovary, fallopian tube, or surrounding tissues are common and found in up to 35% of premenopausal patients and 17% of postmenopausal patients. They are often diagnosed incidentally on physical examination or at the time of pelvic imaging. The differential diagnosis is broad and includes both benign and malignant lesions, as well as gynecologic and non-gynecologic lesions. The patient’s age, family history, physical exam, imaging findings, and serum marker levels can aid with narrowing the differential. Risk factors for ovarian cancer include age, family history of ovarian cancer or genetic predisposition for ovarian cancer, nulliparity, early menarche, late menopause, and endometriosis. Management aims include identifying need for emergent surgery, identifying malignancy, managing symptoms, and preserving fertility when appropriate. Management options for pelvic masses include expectant management, surveillance, and surgical management. While minimally invasive surgery is often the preferred surgical approach for removal of an adnexal mass, open surgery may be required for larger masses or those concerning for malignancy. Ovarian cancer is the second most common gynecologic malignancy after uterine carcinoma and is the deadliest gynecologic cancer in the United States. Approximately 95% of ovarian cancer arise from the epithelial cells and include high grade serous, low grade serous, endometrioid, clear cell, and mucinous carcinoma. Most patients have advanced staged disease at the time of ovarian cancer diagnosis. While surgery alone can cure most patients with early-stage disease, most patients present with advanced stage disease and will require a combination of both surgery and chemotherapy. The standard chemotherapy regimen includes a combination of platinum- and taxane-based chemotherapy. Five-year overall survival rates are 89% for stage I, 71% for stage II, 41% for stage III, and 20% for stage IV disease.