Differential Diagnosis for Progressive Bloating in a 60-year-old Woman
- Single most likely diagnosis
- Ovarian cancer: The presence of a firm, immobile mass in the left adnexa, rectovaginal nodularity, elevated CA-125 levels, and the patient's symptoms of progressive bloating, early satiety, and constipation are highly suggestive of ovarian cancer. The patient's age and postmenopausal status also increase the likelihood of this diagnosis.
- Other Likely diagnoses
- Uterine cancer: Although less likely than ovarian cancer, uterine cancer could present with similar symptoms, including bloating and a pelvic mass. However, the absence of postmenopausal bleeding makes this diagnosis less likely.
- Endometriosis: Although endometriosis is more common in premenopausal women, it can occur in postmenopausal women, especially if they are on hormone replacement therapy (which this patient is not). The rectovaginal nodularity could be consistent with endometriosis, but the presence of a large adnexal mass and elevated CA-125 makes this diagnosis less likely.
- Do Not Miss diagnoses
- Tubo-ovarian abscess: Although less likely given the patient's stable vital signs and lack of fever, a tubo-ovarian abscess could present with a pelvic mass and elevated CA-125. This diagnosis is critical to consider because it requires prompt antibiotic treatment and possible surgical intervention.
- Colon cancer: The patient's symptoms of constipation and bloating could be consistent with colon cancer, especially if the tumor is obstructing the bowel. A thorough evaluation of the colon is necessary to rule out this diagnosis.
- Rare diagnoses
- Lymphoma: Although rare, lymphoma could present with a pelvic mass and elevated CA-125. This diagnosis would require further evaluation with imaging and biopsy.
- Sarcoma: A sarcoma of the uterus or ovary is a rare diagnosis that could present with a pelvic mass and elevated CA-125. This diagnosis would require further evaluation with imaging and biopsy.