4th Edition

Chapter 19: The sister’s cyst

A 63-year-old nun complained to her GP of swelling of her lower abdomen. She was referred for an ultrasound.

  • 1. What does the pelvic ultrasound show?

    Correct answer:

    Pelvic ultrasound showed a complex ovarian cyst with:

    • Multiple septations
    • A solid component
    • The wall and solid element were highly vascularized

  • 2. What factors in her menstrual history affect the risk of ovarian cancer?

    Correct answer:

    • Early menarche
    • Late menopause
    • Nulliparity
    are all associated with a higher risk of ovarian cancer.

She had an MRI scan prior to planned surgery.

  • 3. What does the MRI scan show?

    Correct answer:
    An MRI scan was organized that confirmed a large pelvic mass that contains several thickened septa within it as well as a solid component.

  • 4. What tumour marker would you request?

    Correct answer:
    Serum CA-125
    Epithelial ovarian cancers usually produce the glycoprotein tumour marker CA-125. 80% of patients with advanced ovarian cancer have raised CA-125 levels in the blood. High levels can also occur with almost any gynaecological, pancreatic, breast, colon, lung or hepatocellular tumour. CA-125 levels also are elevated in a number of benign conditions including endometriosis, pancreatitis, pelvic inflammatory disease and peritonitis. So a raised CA-125 level is not sufficient for the diagnosis of ovarian cancer but changing levels may be used to monitor treatment and in follow-up after treatment.

At surgery an ovarian mucinous cystadenocarcinoma was resected. She had a total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy. Microscopic tumour deposits were present in the omentum, making the tumour stage III. Following surgery she was treated with adjuvant combination paclitaxel and carboplatin chemotherapy and prayer.

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