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. 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. 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. 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.
US Pharmacist. 2010;35(7):1-4. © 2010 Jobson Publishing
Cite this: Ovarian Cysts: A Review - Medscape - Jul 20, 2010.