Womens Health

After menopause, are not most ovarian masses malignant?

Just as there is an increased chance of an ovarian tumor being malignant at older ages, so is the chance after menopause. Benign pelvic/ovarian masses occur with almost equal frequency before and after menopause.

Risk of Malignancy Distribution by Menopause

Premenopause 175 (60%) 18 (24%)
Postmenopause 115 (40%) 57 (76%)

Does the CA-125 test accurately predict ovarian cancer?

CA-125 is an ovarian cancer antigen test but it is also positive in many cases of benign pelvic and abdominal disease, especially premenopausal. Fibroids, diverticulitis, liver disease, benign ovarian tumors, endometriosis and other nonmalignant sources can cause an elevation in CA-125.

Normal values in most labs are 35 u/ml or less and only when the values are over 100 u/ml is there a great concern for malignancy. Benign causes can be associated with levels higher than 100 u/ml while malignancies, especially early Stage I ovarian cancer can be associated with normal or equivocal levels (35-100 u/ml).

Risk of Malignancy Distribution by CA-125 Level

CA-125 (u/ml) Benign
(average of values)
42 611
(middle value)
17 95
(lowest to highest)
1-2700 8-11,260



What changes on ultrasound are most worrisome for malignancy?

There have been different ultrasound scoring systems to try to predict malignancy. Anytime the ultrasonographer sees the following characteristics, there may be an increased chance of malignancy beyond just a simple cyst:

  • multiloculated cysts (septations within a cystic area)
  • solid areas
  • bilateral lesions
  • ascites (fluid in the pelvic/abdominal cavity)
  • evidence suspicious for intraabdominal metastases

Giving a score of one for any of the above findings, the risk of malignancy cases were divided into :

Risk of Malignancy by Ultrasound Findings

Ultrasound score Benign
0 79 (27%) 3 (4%)
1 112 (39%) 13 (17%)
2-5 99 (34%) 59 (79%)

Note that many (34%) benign masses have more than one characteristic of malignancy.


Table of Contents
1. Ovarian Mass
2. Is age a factor?
3. When is surgery best?
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