Snapshot A 68-year-old woman presents to her gynecologist with pelvic pain and discomfort. Her symptoms are associated with a bloated sensation with increased urinary frequency. She became menopausal at the age of 52. Pelvic examination is notable for an adenxal mass. CA-125 levels are elevated. A transvaginal ultrasound demonstrates an ovarian mass concerning for malignancy. Preparations are made for surgical resection to establish a tissue diagnosis. Introduction Overview malignant neoplasm originating from the ovaries Epidemiology Incidence second most common gynecologic malignancy mean age of diagnosis is 69 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 also known as Lynch syndrome Protective factors breast feeding decreases the risk of breast and ovarian cancer oral contraceptive pills chronic anovulation ETIOLOGY 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 Ovarian biopsy indication to confirm the diagnosis and specify 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