Australian and New Zealand Journal of Obstetrics and Gynaecology 2006; 46: 350–355 350 © 2006 The Authors Journal compilation © 2006 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Blackwell Publishing Asia Short Communication Ovarian cancer in young women Not all ovarian cysts in young woman are benign: A case series and review of the management of complex adnexal masses in young women Jonathan CARTER, Selvan PATHER, Mohammed ABDEL-HADI, Kathryn NATTRESS, Christopher DALRYMPLE and Philip BEALE Sydney Gynaecological Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, and The University of Sydney, New South Wales, Australia Abstract While ovarian cancer is a disease that predominately affects postmenopausal women, up to 13% of affected patients are indeed less than 45 years of age. The diagnosis is often delayed because of the non-specific nature of symptoms and a lack of specific and accurate diagnostic tests, that is, CA125 and ultrasound. In premenopausal women these issues are compounded, further reducing the likelihood of an accurate and early diagnosis. It is important for gynaecologists to have a high index of suspicion and appropriately investigate symptomatic patients and interpret test results critically. Not all ovarian cysts in young women are benign, and a low threshold for surgical evaluation is warranted. Key words: cancer, gynaecological, malignancy, ovary. Introduction Ovarian cancer continues to maintain the dubious distinction as the most deadly gynaecological malignancy. Indeed, in Australia, more women die from ovarian cancer each year than from cervical and corpus cancer combined. While the majority of affected women are postmenopausal and elderly, young and premenopausal women are not immune to this deadly disease. Overall, 13% of ovarian cancers occur in women under 45 years of age. 1–3 Issues relevant to the diagnosis and management of ovarian cancer in young women include a possible delay in diagnosis, often because of the non-specific nature of symptoms, and an incomplete work-up of a woman with a complex adnexal mass. Furthermore, many young women have also undergone a surgical procedure, prior to the diagnosis being confirmed, that may indeed harm or hinder their outcome rather than help them. These procedures include inappropriate laparoscopic drainage and spillage, inappropriate exploration, exploration via a low transverse incision, and an inability to complete the optimal and desired surgical procedure at the initial operation. The consequence of such delay and poor treatment undoubtedly has an adverse effect on survival. 4 The aim of this report is to review 12 cases of ovarian cancer in young women referred to a single gynaecological oncologist at the Sydney Gynaecological Oncology Group (SGOG) over a 6-month period of time. While some of the cases were managed in a perfectly reasonable way, many of the case histories highlight concerns in inappropriate surveillance, preoperative evaluation and intraoperative man- agement. Overall, the aim of the report is to highlight that malignant ovarian tumours, while uncommon do occur in young women and the outcome is not always favourable. Case 1 A 38-year-old woman presented with a huge pelvic–abdominal mass measuring 25 cm in diameter; the mass was described on ultrasound as complex with several solid components with some vascularity, most likely a cystadenoma (Fig. 1). Preoperatively, the serum CA125 level was noted to be normal at 30 IU/mL. A laparoscopic approach was under- taken and the mass was drained intraperitoneally to gain access to the vascular pedicles. The ovary was resected and pathology confirmed serous ovarian carcinoma with positive washings. She was referred to the SGOG and after three cycles of combination chemotherapy was re-explored and widespread small volume disseminated malignancy confirmed. She completed palliative therapy but is dying of disease 10 months after presentation. Correspondence: Professor Jonathan Carter, Royal Prince Alfred Hospital and The University of Sydney, Missenden Road, Camperdown, Sydney, NSW 2050, Australia. Email: jocarter@mail.usyd.edu.au DOI: 10.1111/j.1479-828X.2006.00605.x Received 23 December 2005; accepted 27 March 2006.