Suspected ovarian cancer in a young patient with a congenital heart defect and a history of cardiac surgery and pacemaker implantation – difficult therapeutic decisions

After uterine cancer, ovarian cancer is the second most common female reproductive tract malignancy. In Poland, in 2015, there were 3735 new cases and 2738 deaths from ovarian cancer. Over 80% of all cases are diagnosed in women aged over 50, whereas only 6% – before 35 years of age. Most cases are diagnosed, when clinical symptoms have already appeared, and the disease is at least locally advanced. The case presented below describes a very young 28-year-old woman with a tumour in the pelvis, ascites and very high Ca 125 and HE 4 levels. The clinical symptoms as well as laboratory and imaging tests were suggestive of epithelial ovarian cancer that required urgent surgery due to progression of the disease. The surgery posed a significant risk of complications, but owing to the deterioration of the patient’s condition it was considered necessary. The patient was born with a severe, complex heart defect, had undergone two cardiac surgeries, and had a pacemaker (first VVIR, then DDD). She was also intensively treated for iatrogenic HCV infection and hypothyroidism. A multidisciplinary team (a gynecologist, cardiologist and anesthetist) were behind the decision to carry out a major gynecological operation which ended with success. For the past 6 years, the patient has been under constant oncological follow-up and enjoys a good health.