Bloating Burden

A 62-year-old parous woman with no significant past medical history presents with a 3-month history of progressive abdominal bloating, unintentional weight loss, and early satiety. She has also noticed an increase in abdominal girth despite a decreased appetite. The patient denies fever, nausea, vomiting, changes in bowel habits, or urinary symptoms. Her family history is notable for a sister diagnosed with breast cancer at age 55. On examination, the patient appears fatigued but not acutely ill. Her blood pressure of 118/76 mmHg, pulse 88 / min, respiratory rate of 18 /min, and a temperature of 98.4°F (36.9°C). Abdominal examination reveals a protuberant abdomen with dullness to percussion over the flanks and a positive fluid wave, suggesting the presence of ascites. No palpable masses are felt. The pelvic exam reveals bilateral adnexal fullness with mild tenderness, but no vaginal bleeding or discharge is noted. There is no palpable lymphadenopathy. Laboratory results show an elevated serum CA-125 level of 700 U/mL (normal <35 U/mL). Imaging with pelvic ultrasound reveals a complex, multiloculated ovarian mass with associated ascites.