Management of ovarian masses in the older woman

Ovarian masses are frequently encountered among older women. While postmenopausal women are at elevated risk of ovarian cancer, even among this population most adnexal masses (ovarian and extra-ovarian) are benign. The evaluation of an adnexal mass seeks to identify patients with malignancy, especially ovarian cancer, who require surgical management while avoiding unnecessary surgery among women with benign conditions. Pelvic ultrasound is the first-line imaging study for characterizing an ovarian mass and usually the only necessary imaging modality. When ultrasound is equivocal, magnetic resonance imaging may further characterize an adnexal mass. Despite frequent use, serum tumor markers are of limited use in differentiating benign from malignant masses. Among women triaged to surgery based on clinical impression and radiologic findings, serum tumor markers may aid in determining which patients should be referred to a gynecologic oncologist. Patients with masses who are at very high risk of ovarian cancer should be referred to a gynecologic oncologist for further management.