CASE REPORT

Suspect Ovarian Cancer In Ascites

Woman

KAIDA SETYARINI

CONSULTANT:
dr. PUTU A. SUARTA, Sp.OG (K)
 CHAPTER I
Introduction
It is the most lethal gynecological malignancy
>25,000 women in USA annually
14,000 deaths annually
Incidence has increased by 30% over the past
decade
Deaths from ovarian cancer increased by 18%
60% of patients present with advanced-stage
disease
The overall survival rate is 38% at 5 years
 Ovarian cancer is extremely hard to diagnose in its early stages. Patients
who are eventually diagnosed with ovarian cancer are typically asymptomatic and
in the late stages where the cancer has metastasized to other organs.

Reproduction factors
Nulliparous
First childbirth after age 35 years
Involuntary infertility
Late menopause and early menarche
Pts. With prolonged period or uninterrupted ovulation
Symptoms and Signs
Early stage asymptomatic
size:10-12 cm
Bloating, abdominal
discomfort, pelvic pressure,
urinary and rectal symptoms
Ascites , pleural effusion and
shortness of breath
Other Symptoms
abnormal menstrual cycles
digestive problems
vaginal bleeding that
occurs between periods
sudden weight gain or loss
back pain with an
unknown reason that worsens
over time
excessive hair growth that
is coarse and dark
 PATIENT IDENTITY
Name : Ny. Oktovina Giyai

age : 49 years

etnicity : Indonesia/Paniai

work : PNS

religion : Kristen Katolik

Birth place : Paniai, 31-03-1968

Address : Padang Bulan

Eduv=cation : S1 Ekonomi

Husband name : Tn. Kalomus Edewai

Husbands job :-

in : 19 September 2017
MENSTRUAL HISTORY
Menarche : 13 years

Cycle of menstruation : Ireguler (cant be describe)

Menstrual habbit : 4 days, dysmenorea () pelvic pain()

Last menstruation : 7th September 2010

LABORATORY EXAMINATION

Leucocyte : 14600/mm3

Erytrocyte : 4,36 106/mm3

Hb : 10,6 g/dL

Hematocryte : 34,2 %

Trombocyte : 644.000/mm3
CHEMICAL FINDING

Indicator Result

ProteinTotal 6,7 g/dL

Albumin 2,5 g/dL

Globulin 4,2
GYNECOLOGY EXAMINATION

I : There is mass with diameter

12 cm
P : we can feel the Solid mass, (-)
 Thorax X-Rays

Indicator Expertise

Cor Right borderline isnt seen

Aeration of Right pulmo not seen,
Pulmo hemothorax dextra fill sinus
costofrenicus dextra, sinus
costofrenicus sinistra was sharp

Expertise Mass in pleural effusion dextra

 DIAGNOSIS

Once an appointment is made with a gynecologist a patient will undergo

several tests to help determine whether or not they have ovarian cancer. A
patients history is taken and a physical exam is performed looking for signs of
ovarian cancer.
The physician will be looking for masses on the ovaries, abdominal masses or
signs of fluid in the abdomen.
Further testing will be ordered if the physician believes there are signs of
ovarian cancer. Imaging studies will be performed to confirmed whether or not
a mass is present.
Ultrasound is the preferred imaging modality of physicians when a patients
ovaries or abdomen are suspected of having a mass.
Ultrasound will also be able to distinguish if a mass is solid, typically a tumor,
or if it is a fluid filled cyst.

In this Case, The diagnose is:

Suspected Ovarian Cancer with Ascites
 TREATMENT

After diagnosis of ovarian

cancer several treatment
options are available.
The main treatments for
ovarian cancer are surgery,
chemotherapy, hormone
therapy, targeted therapy
and radiation therapy
 NEXT..
Radiation therapyUsed to treat all stages and types of ovarian cancer.
Surgery may be the only treatment needed for some early stage ovarian cancers.
Surgery may include any one or all of the following:
1. Total hysterectomy, removal of the uterus
2. Bilateral salpingo-oophorectomy, removal of both ovaries and fallopian
tubes, however if
3. The cancer is only in one ovary and the patient wishes to try and get
pregnant the
4. Unaffected ovary and fallopian tube will not be removed
5. Complete or partial removal of the omentum, the fatty layer that covers
and pads organs in the abdomen.
6. Lymph nodes and other tissues in the pelvis and abdomen will be
examined, biopsied and/or removed
7. Debulking, removing as much of the tumor and/or tumors as possible
 Chemotherapy is the use of drugs to treat any cancer that
may remain after surgery or if cancer.
Chemotherapy for ovarian cancer is typically a combination of
2 or more drugs given intravenously (IV), into the veins, or
intraperitoneal (IP), directly into the abdominal cavity.
 RESUME
A 49-years-old female patient who has 5 children came to
the hospital with abdominal mass. The diagnosis was a
benign complex cyst and no further investigations were
performed. The cyst grew larger after two mounth, and she
have ascites. Ultrasound of the right ovary showed that It
contained homogeneous internal echoes in the cystic
component, with irregular mural projections and internal
vascularity. treatments a conservative surgery was Choosen
For Surgical Staging. For now, The treatment is drainage the
fluid of ascites and the patient given injection therapy.
 CONCLUSION

Female patients diagnosed with ovarian cancer will face

many trials when it comes to fighting this disease.
Females should not ignore symptoms that may point to
ovarian cancer, early diagnosis increases their survival
rate.
Ovarian cancer is deadly, but a well educated women
fighting ovarian, in my opinion, stands a better chance of
survival if she knows exactly what she is facing