Mrs. GN has generally been healthy with no significant past medical history. She is postmenopausal, having stopped menstruating three years ago. She has had three children, all delivered vaginally without complications. There is no family history of ovarian or breast cancer. Over the past six months, she has noticed a gradual increase in abdominal girth, feeling full quickly after eating small amounts of food, and has unintentionally lost about 10 kg. She also reports occasional pelvic discomfort and fatigue.

Mrs. GN lives in an urban area of Harare with her husband. She works as a small business owner and leads a moderately active lifestyle. Her diet is generally balanced, and she has no history of smoking or alcohol use. The couple's children are grown and living independently.

On physical examination, Mrs. GN appears thin but has a noticeably distended abdomen. Palpation of the abdomen reveals a firm, irregular mass in the lower abdomen. No palpable lymph nodes are found, and her vital signs are stable.

A pelvic ultrasound and CT scan of the abdomen and pelvis reveal a large, complex ovarian mass with ascites (fluid accumulation in the abdomen). Blood tests show elevated levels of CA-125, a tumour marker often associated with ovarian cancer.

Suspected advanced-stage ovarian cancer with associated ascites and weight loss.
Management Plan:
1. Referral and Staging:
- Immediate referral to a gynaecologic oncologist for further evaluation.
- Additional imaging, such as a chest CT, to assess for metastasis and staging of the cancer.
- Diagnostic laparoscopy to obtain a tissue biopsy for histopathological confirmation and staging.
2. Treatment Options:
- Surgical Intervention: Debulking surgery to remove as much of the tumour as possible, including the affected ovary, surrounding tissues, and possibly other organs if involved.
- Chemotherapy: Post-surgical chemotherapy with platinum-based agents to target any remaining cancer cells and reduce the risk of recurrence.
- Palliative Care: Symptom management, including pain relief, nutritional support, and psychological counselling.

- Regular follow-up appointments to monitor response to treatment and manage any side effects.
- Ongoing monitoring of CA-125 levels and imaging studies to track the progression of the disease.