Ovarian Cysts: A Review

Cheryl Horlen, PharmD, BCPS


US Pharmacist. 2010;35(7):1-4. 

In This Article

Risk Factors for Malignancy

The risk of ovarian malignancy increases dramatically with age. It is estimated that 13% of ovarian neoplasms in premenopausal women are malignant, compared with 45% in postmenopausal women.[7] A thorough history may reveal other risk factors for ovarian cancer, such as a family history of ovarian or breast cancer, other hereditary cancer syndromes, infertility, and nulliparity.[1] Carriers of the BRCA1 (breast cancer gene 1) mutation have a 60-fold increased risk of developing ovarian cancer by age 60 years, and carriers of the BRCA2 gene mutation have a 30-fold increased risk.[8] Findings on ultrasound that are suspicious for malignancy include the presence of solid components, papillary projections, thick walls, thick septations, increased vascularity within the cyst, bilaterality, and ascites.[1,9]

Serum cancer antigen 125 (CA-125) has been studied as a screening tool for ovarian cancer. Elevated concentrations have been found in approximately 90% of women with advanced-stage epithelial ovarian cancer, but in only 50% of those with stage I ovarian cancer, when the chance of survival is greatest.[1,7] In addition to the low sensitivity, specificity is low because CA-125 concentrations often are elevated in other benign conditions, such as liver disease, kidney disease, uterine fibroids, pelvic inflammatory disease, endometriosis, and pregnancy.[1,7,8] Because these conditions occur more commonly in premenopausal women and ovarian cancer is more common in postmenopausal women, CA-125 measurement is of most benefit in the postmenopausal population.


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