Ovarian Cancer: An Overview
MICHELLE A. ROETT, MD, MPH, and PATRICIA EVANS, MD, Georgetown University/Providence Hospital Family Medicine Residency Program, Colmar Manor, Maryland
Am Fam Physician. 2009 Sep 15 80:609-616.
Patient information: See related handout on ovarian cancer, written by the authors of this article.
Although ovarian cancer may occur at any age, it is more common in patients older than 50 years. Patients often present with nonspecific pelvic or abdominal symptoms. Initial diagnostic tests include transvaginal ultrasonography and serum cancer antigen 125 measurement however, these tests are not specific for ovarian cancer. Conventional treatment includes surgical debulking followed by chemotherapy. Prognosis is typically determined by the cancer stage and grade, although future treatment may depend on tumor genetic composition. Epithelial ovarian cancer is the most common type of ovarian cancer, and because 70 percent of cases are diagnosed at stage III or IV, it is associated with a poor prognosis. Preventive visits provide an opportunity to identify and educate women at increased risk of ovarian cancer, but routine screening is not recommended. Women with a family history of ovarian cancer or a known associated genetic syndrome should be offered genetic counseling or a discussion of available preventive interventions, respectively.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
The USPSTF recommends against routine screening for ovarian cancer.
Differential Diagnosis For Female Pelvic Masses
Submitted: April 26th 2012Reviewed: September 6th 2012Published: February 20th 2013
- Foundation IRCCS, Policlinico San Matteo, Institute of Radiology, University of Pavia
Alfredo La Fianza
Postmenopausal Palpable Ovary Discovered
Mrs. E, a 55-year-old G1,P1 presents as a new patient, having just moved to the area. She admits to missing her annual GYN exams for several years. She describes herself as healthy and active and states that she engages in regular exercise .
HISTORYMrs. E has been married for 35 years, reports one sexual partner , and has never had an abnormal pap test. She cannot remember when she had her last mammogram but thinks it was about five years ago. Her last menstrual period was about four years ago and she reports having gone through hot flashes that were mild but now nonexistent.
EXAMINATIONMrs. E is 5ft 4in tall and weighs 135lbs. Vital signs on physical examination were good: BP 126/76 pulse 86bpm.
On physical examination:HEENT: Normal, no adenopathy, thyroid normalChest: Heart RRR, lung sounds normalBreast: No masses on clinical breast exam. No adenopathyAbdomen: Soft, + BS all 4 quadrantsExternal genitalia: Labial petechiae, sparse pubic hair, no lesionsVestibule/Vagina: Atrophic changesCervix: Parous, clear, pap done Bimanual: Uterus AV, non-tender, smallAdnexa: Left ovary 2X3cm, right ovary non palpableRectal exam: No occult blood, confirms bimanual findings
Palpable ovary in postmenopausal woman vaginal atrophy.
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Initial Actions And Primary Survey
As with any patient in the ED, first consider airway, breathing and circulation in the patient with pelvic pain and vaginal bleeding. Circulation may need to be addressed immediately if the bleeding is heavy or if they have symptoms of poor perfusion such as altered mentation, dizziness, or difficulty breathing. If circulation is inadequate to perfuse the patients brain, this may lead to an airway or breathing problem requiring intubation to protect the airway as well as aggressive volume resuscitation. In the hemodynamically unstable patient, placing two large-bore intravenous lines is a priority, followed by resuscitation with crystalloid fluids followed by blood products if there has been enough blood loss.
If the source of bleeding is suspected to be a potential ectopic pregnancy, the patient’s pregnancy status needs to be established as soon as possible. If positive, it is crucial to determine whether the pregnancy is intrauterine or extrauterine, as a ruptured ectopic is a surgical emergency requiring emergency laparoscopy. Identification of pregnancy location can be accomplished with bedside ultrasonography in the unstable patient. If intrauterine pregnancy cannot be identified on bedside ultrasound, OB/GYN should be consulted immediately for potential surgical management. The LMP and gestational age should be determined as they are important components of the patients history to help guide management.
History and Physical Examination
Pelvic exam setup
What Causes Ovary Pain During Menopause
Perimenopause is a period of up to about a year when your periods will start to taper off. Youll still have some cramps and bleeding. This signifies that your periods arent quite over with. Complicating the matter is the fluctuations of the hormones estrogen and progesterone. This can add to your pain and discomfort. Youll likely experience other menopause symptoms such as hot flashes, vaginal dryness, night sweats, and mood swings or irritability.
There are several conditions that can cause pain in the ovaries during or after menopause. Endometriosis is a condition that causes tissue thats normally only found in the uterus to grow in your ovaries or pelvis. Each time you get a period this tissue will swell and cause pain. While most women stop after menopausal symptoms appear, some women report continuing to have symptoms of endometriosis. If you take hormone therapy, estrogen will make the symptoms worse.
Cancer of the uterus or ovary can cause abdominal pain, but this will also be accompanied by other symptoms like unexplained weight loss, abdominal bloating, vaginal bleeding, and fatigue.
Uterine fibroid can also be a source of abdominal pain. These growths, usually non-cancerous form in the wall of the uterus. Most fibroid begin earlier in life, but it is possible for them to form in women during their 50s. Although fibroid usually stop growing or shrink, many women report problems after their periods have stopped.
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Ovary Pain During Menopause: Should You Worry And When To See Your Doctor
If your periods have stopped, ovary pain during menopause is likely from another cause.
Menopause is that time of life when your periods end because your body stops producing the female hormone estrogen. Youve experienced cramps and pain around the uterus and ovaries for years because of physiological changes that cause the shedding of the lining of the uterus.
Most women welcome menopause symptoms as it means an end to all that discomfort. But what if you are continuing to have cramps and ovary pain? If your periods have stopped, ovary pain during menopause is likely from another cause.
Treatment Of Ovarian Cysts After Menopause
Treatment options may involve surgery to remove the cysts or other treatments for health conditions that may be causing them. Surgery, including ovary removal, may be recommended for postmenopausal women with large, non-simple cysts and other risks factors, such as history of ovarian or breast cancer.
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When Should I Call My Doctor
If any of your postmenopause symptoms bother you or prevent you from living your daily life, contact your healthcare provider to discuss possible treatment. They can confirm you have completed menopause and are in postmenopause.
Some questions you might ask are:
- Are these symptoms normal for people in postmenopause?
- Is there treatment for my symptoms?
- Is hormone therapy still an option?
- What can I do to feel better?
If you experience any vaginal bleeding during postmenopause, contact your healthcare provider to rule out a serious medical condition.
How Do I Stay Healthy After Menopause
It is important to maintain a healthy lifestyle, especially as you age and your risk for certain medical conditions increases. Some ways for people in postmenopause to stay healthy include:
- Exercising regularly. Walking, doing yoga or strength training can help lower your risk for many medical conditions.
- Weight-bearing exercises can strengthen your bones and muscles.
- Eating a healthy diet. Foods like fruits, vegetables, lean meats and whole grains should make up the bulk of your diet. Avoid lots of salt or sugar and limit your consumption of alcohol.
A note from Cleveland Clinic
Going through menopause can be uncomfortable and present new challenges and health concerns. Speak with your healthcare provider about any symptoms you feel or questions you have. They can help make sure you are supported through this time and get the care you need.
Last reviewed by a Cleveland Clinic medical professional on 10/05/2021.
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Causes Of Ovarian Cysts After Menopause
Ovarian cysts develop when a follicle fails to break open and release an egg during ovulation, and thus retain their fluid. Cysts can also happen after an egg has been released from a follicle.
Ovarian cysts are most commonly caused by hormonal imbalances. Other types of ovarian cysts might be related to certain health conditions, including endometriosis.
Management Of Masses Caused By Pelvic Inflammatory Disease
The main treatment of the condition in question is antibiotics. Since more than one organism causes pelvic inflammatory disease, at least two antibiotics could be essential.
The antibiotics could be taken through veins or oral. If you take oral antibiotics, be sure to finish your medication, even when the symptoms disappear. It is because the infection may still be present after the symptoms go away.
Make sure you tell your physician about your progress, three days after starting the treatment. If the condition isn’t improving, revisit the medical expert, and have another examination. The doctor may choose to conduct a computed tomography scan or an ultrasound to check if you have an abscess. If it exists, surgery could be an option.
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Ovarian Benign And Malignant Tumours: Anatomical And Pathological Classification
Malignant ovarian tumours represent the fifth death cause among US female population the sixth neoplasia for frequency, the second, most frequent female tumour after endometrial ones and the first death cause as far as gynaecologic tumours are concerned .
This illness is more frequent in peri-or post-menopausal women, but there are characteristic histological types for each age group. In adolescents and in women who are younger than 20, half of the tumours comes from germ cells in post menopausal age they have a most frequent epithelial origin.
The causes for the occurrence of ovarian cancer are not defined epidemiological studies show that the most affected people by ovarian cancer are represented by peri or post-menopausal, middle or upper class, with no children or just one and with problems in getting pregnant women.
The majority of ovarian tumors begins without well-defined symptoms as a matter of fact early stages are mostly incidental findings representing just a 20%. In most of the cases they are diagnosed when they are at an advanced stage, that is when the cancer has spread outside the pelvis. The most common symptoms are given by the effect on neighbouring organs: polyuria, dysuria, constipation, sudden increase in abdominal circumference, amenorrhoea, polymenorrhea.
In table 4 WHO histological classification of the tumours of the ovary is presented.
Iii Symptoms Of Menopause:
4. Atrophic Changes Vagina *vaginitis due to thinning of epithelium, PH and lubrication. *dysparnuedue to decrease vascularity and dryness Decrease size of cervix and mucus with retract of segumocolumnar junction into the endocervical canal. Decrease size of the uterus, shrinking of myoma & adenomyosis. Decrease size of ovaries, become non palpable. Pelvic floor – relaxation prolapse. Urinary tract atrophy lose of urethral tone caruncle Hypertonic Bladder – detrusor instability Decrease size of breast and benign cysts.5. 6.
Skin Collagen collagen & thickness elasticity of the skin. Reversl of premenstural syndrom
How Do You Know You’re In Postmenopause
Your healthcare provider will be able to tell you if you’re in postmenopause based on your symptoms and how long it’s been since your last menstrual period. In some cases, your healthcare provider will take a blood sample and check your hormone levels to confirm you’ve gone through menopause. Remember, you’re not considered to be through menopause until it’s been over one year since youve had a period.
Uncertain Etiology Or An Alleged Malignancy
Excluding the possibility of malignancy is the primary goal of a pelvic mass evaluation. If you have a mass that is alleged to be malignancy after your initial evaluation, surgical exploration is necessary.
Surgical evaluation is the standard approach to pelvic masses evaluation. It is because there are no non-invasive techniques for ovarian cancer diagnosis. However, this technique causes most patients to undergo surgery. For instance, an ovarian cancer screening trial conducted by Ryan A, Menon U, Jacobs IJ, et al. discovered that for every peritoneal or ovarian cancer detected using an ultrasound, an additional ten patients underwent surgery for benign or normal pathology. Nevertheless, ovarian cancer prognosis is poor unless the condition is treated early.
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What Causes Postmenopausal Bleeding
Vaginal bleeding during postmenopause isn’t a normal side effect of decreasing hormone levels. In some cases, the dryness in your vagina could cause some light bleeding or spotting after sex. In other cases, it could indicate a condition like endometrial hyperplasia or uterine fibroids, infections like endometritis, or cancer. Contact your healthcare provider if you experience any vaginal bleeding so you can be evaluated.
Alterations Of The Sacral Canal
The mass appears as a simple cyst, homogeneous and anechoic at US.
CT scan, but mainly MRI can precisely detect the origin of the lesion. It is possible to study the alterations of the sacrum, anterior defects, and the whole morphology of the sacrum-coccyx using sagittal reconstruction with CT. The mass is like a simple cyst, with no enhancement and without capsule.
The main signal characteristic is T2 hyperintensity at MRI. Finally, both CT and MRI is able to perfectly detect the neck of the meningocele .
MPR sagittal reconstruction of a CT scan showing an anterior sacral meningocele direcly connected to the medullar canal.
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Aging Changes In The Female Reproductive System
The time before menopause is called perimenopause. It may begin several years before your last menstrual period. Signs of perimenopause include:
- More frequent periods at first, and then occasional missed periods
- Periods that are longer or shorter
- Changes in the amount of menstrual flow
Eventually your periods will become much less frequent, until they stop completely.
Along with changes in your periods, physical changes in your reproductive tract occur as well.
AGING CHANGES AND THEIR EFFECTS
Menopause is a normal part of a woman’s aging process. Most women experience menopause around age 50, though it can occur before that age. The usual age range is 45 to 55.
- The ovaries stop making the hormones estrogen and progesterone.
- The ovaries also stop releasing eggs . After menopause, you can no longer become pregnant.
- Your menstrual periods stop. You know you have gone through menopause after you have had no periods for 1 year. You should continue to use a birth control method until you have gone a whole year without a period. Any bleeding that occurs more than 1 year after your last period is not normal and should be checked by your health care provider.
As hormone levels fall, other changes occur in the reproductive system, including:
Are There Any Health Risks Associated With Postmenopause
People in postmenopause are at an increased risk for several conditions:
Estrogen helps protect against cardiovascular diseases like heart attack, heart disease and stroke. It is also common for people in postmenopause to become more sedentary, which contributes to high cholesterol and high blood pressure. These factors combined can increase a womans risk for cardiovascular diseases after menopause. A healthy diet, not smoking and getting regular exercise are your best options to prevent heart disease. Treating elevated blood pressure and diabetes as well as maintaining cholesterol levels are also ways to lower your risk.
People lose bone more rapidly after menopause due to decreased levels of estrogen. You may lose up to 25% of your bone density after menopause . When too much bone is lost, it increases your risk of developing osteoporosis and bone fractures. The bones of the hip, wrist, and spine are most commonly affected. Bone mineral density testing, also called bone densitometry, can be done to see how much calcium you have in certain parts of your bones. The test is used to detectosteoporosis and osteopenia, a precursor to osteoporosis.
Mental health issues
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What Can I Do To Prevent Osteoporosis
Osteoporosis isnt entirely preventable, but you can take steps to strengthen your bones. Eating foods high in calcium like cheese, yogurt, spinach or fortified cereals can help boost calcium intake. Adding a calcium supplement can also help. Some people also need a vitamin D supplement because it helps their body absorb calcium.
How Do I Manage Symptoms Of Postmenopause On My Own
Certain lifestyle or at-home changes can help you manage symptoms of postmenopause. Some of these include:
- Using a water-based vaginal lubricant during sex to make it more pleasurable. Lubricating the vagina helps with dryness and pain.
- Regular exercise, meditation and other relaxing activities can help with depression and other side effects of postmenopause.
- Eating a diet rich in phytoestrogens such as whole-grain cereals, flaxseed, chickpeas and legumes. Reducing caffeine and alcohol intake has also been shown to help.
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Causes & Risk Factors
According to the NIH, each month during a menstrual cycle, a follicle grows on the ovary. A follicle is where an egg is developing. Most months, an egg is released from this follicle. This is called ovulation. If the follicle fails to break open and release an egg, the fluid stays in the follicle and forms a cyst. This is called a follicular cyst.
Another type of cyst occurs after an egg has been released from a follicle. This is called a corpus luteum cyst. Such cysts often contain a small amount of blood.
Ovarian cysts are more common from puberty to menopause. This period of time is known as the childbearing years. Ovarian cysts are less common after menopause.
Taking fertility drugs can cause a condition in which multiple large cysts are formed on the ovaries. This is called ovarian hyperstimulation syndrome. The cysts usually go away after a woman’s period, or after a pregnancy.
Functional ovarian cysts are not the same as ovarian tumors or cysts due to hormone-related conditions such as polycystic ovary syndrome.