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?

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  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?

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  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?

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  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?

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  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.