L.T. is a 62-year-old female patient who consulted to the clinic for abdominal discomfort, vague abdominal pain in lower abdomen, constipation and low to moderated pain with sexual intercourse. She is post-menopausal and her last visit to her OB/GYN doctor was two years ago.

She was at the local Urgent care clinic last month and was discharge with OTC medications for constipation and follow up with PCP. During your physical exam you notice discomfort at deep abdominal palpation in left lower quadrant. On bi-manual pelvic examination you notice a mass of about 4 cm x 3 cm, nodular and with limited mobility on the left lower abdomen.

• Develop the management plan (pharmacological and nonpharmacological).

The management plan for L.T. involves both pharmacological and nonpharmacological interventions. Symptomatically, she may benefit from acetaminophen for pain relief and polyethylene glycol or docusate sodium for constipation management. At the same time, she must avoid NSAIDs or stimulant laxatives until imaging rules out obstruction or other complications. Nonpharmacologically, initial steps include a transvaginal and transabdominal pelvic ultrasound, serum CA-125 testing, and a CT scan of the abdomen and pelvis to evaluate the nature of the mass.

A colonoscopy may also be warranted to assess for potential colorectal pathology. Given the patient’s age and postmenopausal status, urgent referral to a gynecologic oncologist is essential for further evaluation and possible surgical intervention. Meanwhile, supportive care should include education, emotional reassurance, increased dietary fiber and fluids (if no obstruction is present), and monitoring for red flag symptoms like acute pain, vomiting, or weight loss. Prompt follow-up is necessary as further diagnostic results become available.

• Discuss the appropriate diagnostic testing for the patient
• Discuss differential diagnoses with ICD 10 numbers for each.
• Base on the International Federation of Gynecology and Obstetrics (FIGO) give treatment examples for a patient with a Stage IIB Ovarian Cancer.

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