1. Case presentation- Ovarian cancer Agatha Stanek

2. Case presentation 32 year old female patient presents to clinic with bloating. A constant sense of abdominal fullness Abdominopelvic cramping Fatigue; patient is quite pale Weight loss and a loss of appetite

3. Patient hx Medical hx: Appendicitis 2 years ago All immunizations are current- except HPV Family hx: Grandmother and aunt both died of breast cancer Father was an alcoholic

4. Social hx Patient is married and has been trying to conceive for 6 months now Supportive husband and close- knit family Lives with husband in small apartment downtown Occupational hx Patient recently graduated from law school and has begun practicing

5. Physical Exam HEENT: PERRLA, EOMI Abd: Ascites, tenderness (+) hepatosplenomegaly Cardio: RRR

6. Differential Diagnosis Colitis Hepatic failure with ascities Diverticulitis Gastrointestinal malignancy Tubo-ovarian abscess Pelvic kidney

7. Laboratory Tests Liver function tests to rule out hepatic involvement CBC Urinalysis Chorionic gonadotropin- check if patient is pregnant

8. Imaging Tests MRI:

9. Diagnosis Ovarian cancer. Stage? 4 Additional tests: colonoscopy, x-rays

10. Treatment Surgical staging Chemotherapy and/ or radiotherapy- refer to oncologist Biopsy of omentum and uterus Inspect peritoneal surfaces, liver, small intestine and bowel for tumor Pelvic and para-aortic lymph node biopsy

11. Prognosis/ Follow-up Referral for palliative in home care/ at hospice Palliative chemotherapy if desired

12. Possible complications Pleural effusion Adverse reactions to chemotherapy or radiotherapy Bowel obstruction Malnutrition Electrolyte disturbances Fistula formation Breast carcinoma Death