? Ovarian cancer v. Decompensated liver failure

57-year-old female with an ovarian mass for Investigation.


  • Liver disease
    • Long history of untreated HCV
    • Now diagnosed with Childs Pugh B liver cirrhosis – albumin 20, bilirubin 64, platelets 57.
    • Recent admission with decompensation – severe hydrothorax treated with diuretics.
    • Antivirals recently commenced but not with curative intent.
    • Letters suggest gastro teams and gynae team all aware of both issues.
  • Ovarian mass
    • Incidental finding although some abdominal discomfort
    • 7.7cm2 
    • Ca125 274 (could be elevated due to liver disease)
  • Asthma
  • PAF 


Should surgery proceed?

  • Phone call to gastroenterology team: 
    • High risk of haemorrhage (very difficult to control) with any abdominal surgery, especially laparoscopic, due to portal hypertension.
    • High risk of postoperative decompensation, encephalopathy, infection, and wound breakdown.
    • Patient requires urgent variceal banding, but this will worsen portal hypertension.
    • Delay of 2/12 to enable gastroscopy, ongoing antiviral treatment, anti-portal HTN treatment, repeat imaging, and possible mild improvement.
  • General opinion at the meeting was that the real risks highlighted by the gastroenterologist superseded the theoretical risks of a delayed diagnosis of a possible ovarian cancer (patient unlikely to be a candidate for radical curative surgery or chemotherapy). See attached summary article.
  • TIPS (or similar procedure) may be an option to offload portal hypertension prior to consideration for gynae surgery – for further discussion after 2/12 delay.