Ovarian Cancer Initial Assessment

History

The diagnosis of ovarian cancer may be difficult because symptoms are nonspecific. A thorough medical history should be taken from the woman with specific attention to risk factors or protective factors for ovarian malignancy and a family history of ovarian or breast cancer. The patient may be referred for genetic risk evaluation.  

The most frequent symptoms of ovarian cancer are abdominal discomfort or vague pain, abdominal fullness, bowel habit changes, urinary urgency or frequency, early satiety, dyspepsia, and bloating. Irregular menses, urinary frequency and/or constipation, and occasionally, dyspareunia are common during the early stage of the disease. Abdominal distention, bloating, constipation, nausea, anorexia, or early satiety are observed when the disease is in the advanced stage. Occasionally, patients may present with bowel obstruction due to intraabdominal mass or shortness of breath due to pleural effusion. The most common presenting symptom in children and adolescents is abdominal pain, although precocious puberty, irregular menses, or hirsutism may also be present.  

The presence of 1 of 6 symptoms (ie pelvic pain, abdominal pain, increased abdominal size, bloating, difficulty eating, and early satiety) occurring for >12 days per month for <1 year has a 56.7% sensitivity for early-stage ovarian cancer and a 79.5% sensitivity for advanced-stage ovarian cancer. 

Physical Examination

Pelvic examination is not sensitive for detecting ovarian masses but the presence of a pelvic mass at clinical evaluation is an important sign of possible ovarian cancer. A rectovaginal examination should also be performed to maximize the opportunity to detect a mass. Space-occupying mass in the lesser pelvis, significantly enlarged (>10 cm) ovary, ovarian irregularity, nodular or fixed pelvic mass, bilateral lesions, nodules in the cul-de-sac, palpable mass in the pleural abdomen, ascites and/or pleural fluid, increase in prolapse of uterus and/or vagina, enlarged supraclavicular lymph node, Sister Mary Joseph Nodule (a deep subcutaneous nodule in umbilical area associated with metastasizing intra-abdominal cancer) should elevate concern.