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usmle step 2 ck

Ovarian Cancer

Often late-presenting gynecologic malignancy causing vague bloating, early satiety, pelvic/abdominal pain, ascites, and adnexal mass, with no recommended screening for average-risk patients

Review date
reviewed 2026-05-04
Reading time
8 min read
Author
Dr Kola Tytler MBBS CertHE MBA MSt MRCGP
Obstetrics & Gynecologyless-commonmalignancy
On this page
Condition details
Obstetrics & Gynecology
less-common
8 min read
reviewed 2026-05-04
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About This Page

This is a clinician-written, evidence-based summary aligned to the USMLE Step 2 CK Content Outline. It is intended for medical students preparing for USMLE Step 2 CK. Management reflects current ACC/AHA, USPSTF, and APA guidelines. Always cross-reference with UpToDate, institutional protocols, and clinical judgment.

Key points

  • Ovarian cancer often presents late with vague bloating, early satiety, pelvic pain, urinary symptoms, or weight loss
  • No routine ovarian cancer screening is recommended for average-risk asymptomatic patients
  • Transvaginal ultrasound plus CA-125 helps risk-stratify an adnexal mass but is not average-risk screening
  • Concerning features: postmenopausal mass, solid components, papillary projections, ascites, nodularity, elevated CA-125, family history
  • Suspected ovarian cancer should be referred to gynecologic oncology before surgery

Overview

Ovarian cancer includes epithelial ovarian, fallopian tube, and primary peritoneal cancers. High-grade serous carcinoma is the most lethal common subtype and often arises from the distal fallopian tube. Symptoms are nonspecific, causing delayed diagnosis.

Epidemiology

Ovarian cancer is less common than endometrial cancer but causes more deaths because it is usually diagnosed late. Risk factors include age, BRCA1/2, Lynch syndrome, family history, nulliparity, infertility, endometriosis for certain histologies, and lifetime ovulatory exposure.

Clinical Features

Symptoms
Persistent bloating or increased abdominal girth
Early satiety, nausea, decreased appetite
Pelvic or abdominal pain/pressure
Urinary urgency/frequency from mass effect
Weight loss, fatigue, dyspnea from ascites/effusion
Signs
Adnexal mass
Ascites or abdominal distension
Nodular or fixed pelvic mass
Pleural effusion
Normal pelvic exam does not exclude ovarian cancer

Investigations

First-line
Transvaginal ultrasoundFirst-line for adnexal mass; assess complexity, solid areas, papillary projections, bilaterality, ascites
CA-125Risk stratification and monitoring; nonspecific in premenopausal conditions
Pregnancy testRequired in reproductive-age adnexal mass/pelvic pain
Second-line
CT chest/abdomen/pelvisStaging and surgical planning when malignancy suspected
Additional tumor markersAFP, beta-hCG, LDH for germ cell; inhibin for sex cord-stromal tumors
Genetic risk assessmentBRCA, Lynch, multigene testing for treatment and family counseling
Specialist
Gynecologic oncology referralBefore surgery for suspicious mass
Surgical staging/debulkingHistology and cytoreduction; avoid non-oncologic cyst aspiration

Management

ACOG Guidance on Evaluation of Adnexal Masses and USPSTF Ovarian Cancer Screening Recommendation
1
Screening/prevention
  • Do not screen average-risk asymptomatic patients with CA-125 or TVUS
  • Strong family history/pathogenic variants need genetic counseling
  • Risk-reducing salpingo-oophorectomy for selected BRCA/Lynch patients after childbearing
  • Combined OCPs reduce ovarian cancer risk
2
Suspicious adnexal mass
  • Refer to gynecologic oncology before surgery if malignant features present
  • Risk features: postmenopause, elevated CA-125, solid/complex mass, ascites, nodularity, metastases, family history
  • Avoid aspiration of suspicious cysts
3
Treatment
  • Surgical staging and cytoreductive debulking
  • Platinum-taxane chemotherapy for many advanced epithelial cancers
  • PARP inhibitors/targeted therapy based on BRCA/HRD and setting
  • Fertility-sparing surgery in selected early germ cell/borderline tumors

Complications

  • Peritoneal carcinomatosis: Ascites, bowel symptoms, advanced disease
  • Malignant bowel obstruction: Late peritoneal spread
  • Pleural effusion: Dyspnea and upstaging
  • Venous thromboembolism: Malignancy-associated hypercoagulability
  • Hereditary cancer risk: BRCA/Lynch affect relatives and prevention
USMLE Step 2 CK Exam Tips
  • 1No ovarian cancer screening for average-risk asymptomatic patients
  • 2CA-125 is nonspecific: endometriosis, fibroids, PID, pregnancy, menses
  • 3Postmenopausal + complex adnexal mass + ascites = ovarian cancer until proven otherwise
  • 4Suspected ovarian cancer = gynecologic oncology referral before surgery
  • 5BRCA increases ovarian/breast; Lynch increases ovarian/endometrial/colon
  • 6Oral contraceptives are protective
  • 7Bloating + early satiety + adnexal mass is classic

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Verified Sources & References

USPSTF Ovarian Cancer Screening Recommendation
American Cancer Society — Ovarian Cancer
ACOG Clinical Guidance — Adnexal Masses
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