Your patient is a 63-year-old postmenopausal female with complaints of bloating, left lower quadrant abdominal pain, and feeling of abdominal fullness
On physical examination, the abdomen is non-tender with shifting dullness and there are enlarged left sided inguinal lymph nodes. Pelvic examination reveals slight adnexal tenderness. The clinician should have a high index of suspicion of:
A. Endometriosis
B. Ovarian cancer
C. Uterine cancer
D. Ovarian cyst
ANS: B
In the postmenopausal female, early symptoms of ovarian cancer are vague and include mild lower abdominal discomfort, feelings of fullness, bloating, distension, nausea, dyspepsia, constipation, and urinary frequency if the tumor is large. The CA-125 blood test by immunoassay can be used as a diagnostic tool. The characteristics typical of a malignant ovarian mass include solid, fixed, nodular, non-tender, and bilateral. The abdominal examination is essential looking for distension, changes in percussion, or ascites. As the cancer metastasizes, lymphadenopathy occurs, especially in the inguinal and supraclavicular areas.
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