In a postmenopausal patient with an ovarian cyst greater than 8 cm or elevated CA-125, what is the recommended management?

In a postmenopausal patient with an ovarian cyst greater than 8 cm or elevated CA-125, what is the recommended management?

• A. Observation
• B. Medical therapy
• C. Chemotherapy
• D. Laparoscopy or laparotomy

Answer: (D)

In postmenopausal patients, the risk that an ovarian mass is malignant is higher, so when the cyst is large (greater than about 8 cm) or CA-125 is elevated, the goal is to obtain a definitive diagnosis and proper staging rather than watchful waiting. Surgical exploration allows removal of the mass and thorough staging with histopathology, which is essential to determine if cancer is present and, if so, guide further treatment. Laparoscopy is preferred when feasible, but laparotomy is used if the mass is very large or suspicion for malignancy is high and complete staging is needed. Observation and medical therapy won’t resolve a potential malignancy, and chemotherapy is reserved for confirmed cancer after surgical diagnosis.

In postmenopausal patients, the risk that an ovarian mass is malignant is higher, so when the cyst is large (greater than about 8 cm) or CA-125 is elevated, the goal is to obtain a definitive diagnosis and proper staging rather than watchful waiting. Surgical exploration allows removal of the mass and thorough staging with histopathology, which is essential to determine if cancer is present and, if so, guide further treatment. Laparoscopy is preferred when feasible, but laparotomy is used if the mass is very large or suspicion for malignancy is high and complete staging is needed. Observation and medical therapy won’t resolve a potential malignancy, and chemotherapy is reserved for confirmed cancer after surgical diagnosis.