Approach

Signs and symptoms

If symptoms are present, they are often vague and non-specific. Patients with early disease are typically asymptomatic; thus, a majority of patients present in advanced stages of the disease.[1] Common symptoms are abdominal bloating, nausea and emesis, early satiety, dyspepsia, increased abdominal girth, abdominal cramping, or a change in bowel habit suggestive of advanced disease. On occasion, patients with early stage disease present with pelvic pain or pressure owing to the presence of an ovarian torsion; however, most women with early stage disease are asymptomatic.[1] Because no symptom or sign is pathognomonic, ovarian cancer must be suspected with any of these symptoms.[24][25]

Physical findings are varied and may include ascites, pleural effusion, palpable mass on pelvic examination, and abdominal distension that is dull to percussion. Patients may appear malnourished if they have significant GI symptoms. Findings consistent with ascites (e.g., fluid wave, shifting dullness) or a right-sided pleural effusion (e.g., diminished breath sounds or rales present) can often be detected. On pelvic examination, a mass might be appreciated in the adnexa or recto-vaginal space. Any pre-menopausal woman with an enlarged ovary or post-menopausal woman with a palpable ovary should be sent for additional evaluation to rule out malignancy.

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