Ovarian masses and ovarian cancer foundations

Foundations

• Symptoms of ovarian cancer are vague and late: bloating, early satiety, pelvic or abdominal pain, urinary frequency, persisting for weeks. A new ovarian mass after menopause, or ascites, is cancer until shown otherwise.
• Triage of an adnexal mass: ultrasound morphology (simple, unilocular and under 5 to 10 cm is almost always benign; solid components, papillary projections, thick septa, ascites and Doppler flow are concerning; the IOTA simple rules and ADNEX model formalise this), CA-125 (raised in many benign conditions before menopause: endometriosis, fibroids, infection, menstruation), and the Risk of Malignancy Index combining menopausal status, ultrasound and CA-125.
• Germ-cell tumours in the young (AFP, hCG, LDH); sex cord-stromal tumours produce hormones; epithelial cancers in the older woman, most from the fallopian tube.
• BRCA1 and BRCA2 and Lynch syndrome: genetic testing is offered to all with high-grade serous cancer; risk-reducing salpingo-oophorectomy for carriers after childbearing. Opportunistic salpingectomy at other pelvic surgery reduces population risk.
• Treatment: staging surgery with cytoreduction by a gynaecological oncologist, platinum-taxane chemotherapy, PARP inhibitors for maintenance in BRCA and homologous-recombination-deficient disease.