2. 56 year old post menopausal woman
presented to her gynecologist with urinary
frequency and persistent abdominal bloating.
What further history will you ask for?
What are the expected examination findings?
What are the investigations done?
3. Any other urinary symptoms
Abdominal or pelvic pain, Backache
Changes in bowel habits
Any bleeding or discharge P/V
Unexplained weight loss or fatigue
Obstetric history: Parity index
Menstrual history: Menarche & Menopause
Use of OCPs
Family history of breast, colon and rectal
carcinoma
Cigarette smoking
4. 1) General examination
• General appearance
• Pallor
• Icterus
• Lymphadenopathy
• Pedal edema
2) Abdominal examination
• Distended lower abdomen
• Mass arising from pelvis : Cystic and firm
consistency, Mobile in transverse and horizontal
direction, Lower border palpable
• Ascites
• Hepatomegaly (liver metastases)
5. Pelvic examination may reveal a solid,
irregular, fixed mass arising from pelvis.
Chest examination to look for lung
metastases and malignant pleural effusion.
6. Blood investigations:
-Full blood count
-Liver function test
-Renal profile
-Coagulation profile
-Tumour marker
Imaging:
-Transabdominal & Transvaginal ultrasonography
-Chest X-ray
-CT-TAP
Others:
-Risk of Malignancy Index
-ECG
7. Transvaginal ultrasound revealed a complex
mass in right pelvis measuring 4.5 x 5.0 x 7.5
cm.
CA-125 was 622 U/ml
CT showed a right complex pelvic mass,
ascites and omental cake. No other
peritoneal lesions were visualized.
How to manage?
8. Exploratory staging laparotomy
Aim of surgery is complete or optimal
cytoreduction.
Total abdominal hysterectomy, Bilateral
salpingo-oophorectomy, Omentectomy,
Appendicectomy, Collect ascites/peritoneal
washing for cytology, Lymph node dissection
Further debulking may be required:
Resection of bowel, peritoneal stripping,
splenectomy, resection of metastatic/liver
segment.
9. Chemotherapy
Can be given as primary treatment, adjunct
after surgery, relapse of disease, prolong
remission, palliation
1st line: Carboplatin with paclitaxel
Given 3 weeks apart for 6 cycles
After completion, CT scan to assess response
to treatment
Follow up include clinical examination and
tumour marker measurement
