POSTMENOPAUSAL PELVIC MASS

A   70-year-old woman   comes   for annual  examination.    She complains   of

lower   abdominal   discomfort; however,    there   is  no  weight  loss    or  abdominal

distention. On  pelvic  examination a   nontender,  6   cm, solid,  irregular,  fixed,

left    adnexal mass    is  found.  Her last    examination one year    ago was normal.

Postmenopausal pelvic mass is a pelvic mass identified after menopause.
Ovaries in the postmenopausal age group should be atrophic; anytime they are
enlarged the suspicion of ovarian cancer arises.

Ovarian carcinoma is the second most common gynecologic malignancy, with
age 69 the mean age at diagnosis. It is the most common gynecologic cancer
leading to death (1% of women die of ovarian cancer).

Diagnostic Tests.

There is currently no screening test for ovarian cancer. Pelvic U/S is excellent
for finding pelvic masses, but is not specific for identifying which of these are
benign. Only 3% of patients undergoing laparotomy for sonographically detected
pelvic masses actually have ovarian cancer.

GI tract lesions.   Abdominal   pelvic  CT  scan    or  a   pelvic  U/S and GI  studies

(barium enema)  to  rule    out any intestinal  pathology   such    as  diverticular

disease

Urinary tract   lesions.    IVP to  identify    any impingement of  the urinary tract