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Ovarian epithelial cancer — USMLE Step 2 CK MCQ

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HardObstetrics & GynecologyOvarian epithelial cancerUSMLE Step 2 CK

A 66-year-old postmenopausal woman has increasing abdominal girth and early satiety. Ultrasonography shows a 9-cm complex adnexal mass with solid papillary projections, bilateral lesions, and ascites. CA-125 is elevated, and CT shows no distant metastasis, and she is medically fit for surgery. Which next management is most appropriate?

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Correct answer: E — Refer directly to a gynecologic oncologist for operative staging evaluation

The best answer is “Refer directly to a gynecologic oncologist for operative staging evaluation”. A complex postmenopausal mass with papillary projections, bilaterality, ascites, and elevated CA-125 has high malignant potential. Referral before the initial operation improves appropriate staging and cytoreduction by a gynecologic oncologist. Surveillance and hormonal suppression are inappropriate, while percutaneous biopsy risks spillage and is not routine.

Reference: ACOG Adnexal Masses Practice Bulletin: https://pubmed.ncbi.nlm.nih.gov/27776072/