DIAGNOSTIC EVALUATION
Most patients with nonfunctional ovarian tumors are asymptomatic early in the tumors’ evolution; therefore, >70% of these lesions are diagnosed at an advanced stage. Patients with functional tumors commonly present with altered secondary sexual characteristics (e.g., hirsutism or virilization) or reproductive dysfunction; these lesions thus tend to be diagnosed at an earlier stage (Fig. 102-1).
 FIGURE 102-1. A 55-year-old woman with a 30-year history of amenorrhea, hirsutism, and clitoromegaly associated with a benign cystic teratoma. Note coarsening of the facial skin, seborrhea, temporal hair recession, and mustache. |
HISTORY AND PHYSICAL EXAMINATION
The clinical history in children should include growth rate and the time of onset and progression of puberty. In adults, the menstrual pattern, change in libido, body habitus, growth of hair, and pitch of the voice should be recorded. With tumor growth, abdominal distention occurs, and pressure on the bladder or rectum may cause a sensation of pelvic fullness and discomfort. Abdominal and pelvic pain is associated with torsion, hemorrhage, or rupture of a tumor.
A family history of ovarian cancer is the factor most strongly associated with ovarian cancer risk. Studies of inherited ovarian cancer have identified at least three syndromes: the site-specific ovarian cancer syndrome, the breast/ovarian cancer syndrome, and the hereditary nonpolyposis colon cancer/ovarian cancer syndrome.6 Phenotypically, familial ovarian carcinomas are more frequently papillary serous tumors, and evidence exists that women with a genetic predisposition to ovarian cancer may be differentially affected by hormonal levels and metabolism. The occurrence of functioning ovarian tumors is not known to have any particular association with inherited ovarian risk.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
