Review Question - QID 103071

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Ovarian Cancer Presentation Symptoms QID: 103071 (M3.ON.15.48)

QID 103071 (Type "103071" in App Search)

A 61-year-old woman presents to her primary care physician with complaints of increasing abdominal distension over the last 3 months, as well as more recent onset of early satiety and constipation over the last several weeks. She has a past medical history of obesity and diabetes. She states she feels more distended in her abdomen but has lost 10 pounds this past month. The patient has a 20 pack-year smoking history and was an alcoholic with her last drink 7 years ago. Her father died of colon cancer at the age of 62 and her mother died of breast cancer at the age of 45. She takes naproxen and ibuprofen for joint and back pain. Her temperature is 97.4°F (36.3°C), blood pressure is 120/81 mmHg, pulse is 83/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam is notable for an elderly woman who has muscle wasting and a distended abdomen. Ultrasound is performed as seen in Figure A of the left lower quadrant of the abdomen. Which of the following is the most likely diagnosis?

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Alcoholic cirrhosis

0/6

Colon cancer

33%

2/6

Non-alcoholic fatty liver disease

0/6

Ovarian cancer

67%

4/6

Perforated viscus

0/6

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This patient is presenting with a family history of breast cancer (which could be a risk factor for ovarian cancer via BRCA), weight loss, abdominal distension, constipation, and ascites which is concerning for a diagnosis of ovarian cancer.

Ovarian cancer is one of the most deadly gynecologic cancers in the United States. Risk factors include a family history of ovarian cancer and an increased number of ovulatory cycles (such as from infertility, nulliparity, or age older than 50 years). Oral contraceptive use is believed to be protective as it reduces the number of ovulatory cycles. There are numerous different types of ovarian cancer. However, all are deadly due to the typical development of symptoms that do not occur until late in the course of the disease. The classic presentation of ovarian cancer is in an elderly woman with weight loss, bloating, increasing abdominal girth, and ascites. The diagnosis can involve a baseline serum CA-125 level, CT abdomen/pelvis for staging, and colonoscopy when there are symptoms of constipation or GI involvement.

Figure/Illustration A is an ultrasound demonstrating free fluid in the abdomen which is concerning for ascites (hypoechoic arrow marked with red arrows). Ascites is a common finding in ovarian cancer.

Incorrect Answers:
Answer 1: Alcoholic cirrhosis could present with abdominal distension, weight loss, and ascites; however, it would present with other stigmata of liver disease (such as jaundice, icterus, spider angiomata, or palmar erythema) and is unlikely to develop at this time in a former alcoholic.

Answer 2: Colon cancer can present with weight loss, a microcytic anemia, guaiac positive stools, and constipation; however, ascites and bloating are less commonly found in this condition.

Answer 3: Non-alcoholic fatty liver disease can progress to cirrhosis and would present with an elevated ALT > AST as well as other stigmata of liver disease and abnormalities of liver function (such as an elevated PT/PTT).

Answer 5: Perforated viscus presents with sudden onset and severe abdominal pain with peritoneal signs and free air under the diaphragm on radiography. Free fluid in the abdomen in large volumes on ultrasound is not common.

Bullet Summary:
Ovarian cancer presents with bloating, abdominal distension, weight loss, and ascites in an elderly woman.

ILLUSTRATIONS:

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