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This chapter discusses the risk factors, clinical signs, evaluation, prevention and screening, and treatment of ovarian cancer and ovarian masses. Ovarian cancer is the leading cause of death from gynecological malignancy and the fourth most common cause of cancer death in women. Advancing age is the greatest risk factor. Use of oral contraceptive pills reduces the risk of ovarian cancer by 30 to 60%. A review of women with ovarian cancer compared with women with breast cancer or no cancer found that most women with ovarian cancer complained of the four following groups of non-specific symptoms in the 1-3 months before diagnosis: abdominal pain (30%), abdominal swelling (16.5%), GI symptoms (8.4%), and pelvic pain (5.4%). Transvaginal sonography (TVS) is the examination of choice to establish the diagnosis. In menstruating women, pregnancy, pregnancy complications and functional cysts are the most common causes of ovarian masses.
A gynaecological ultrasound examination can be performed transabdominally, transvaginally or, in exceptional cases, transrectally. Irrespective of the route of examination it is always important to optimise the image and to perform a systematic examination. There are two reasons to adopt a systematic scanning technique. First, it will ensure that a complete pelvic examination is performed. Second, if one always scans all the organs in the pelvis in a systematic way, he/she can build up a reference of what is normal, which increases confidence in detecting pelvic pathology. The uterus and ovaries are smaller in postmenopausal women than in women of fertile age. The endometrium has uniform ultrasound morphology because there are no cyclical hormonal changes. The ovaries contain no follicles but one or more inclusion cysts no larger than 10 mm are seen in healthy postmenopausal women.
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