Onkologie. 2012:6(2):59-64

Preoperative diagnosis of ovarian tumors

Daniela Fischerová¹, Michal Zikán¹, Ivana Pinkavová¹, Jiří Sláma¹, Pavel Freitag¹, Pavel Dundr², Andrea Burgetová³, David Cibula¹

¹ Onkogynekologické centrum, Gynekologicko-porodnická klinika VFN a 1. LF UK v Praze

² Ústav patologie VFN a 1. LF UK v Praze

³ Radiodiagnostická klinika VFN a 1. LF UK v Praze

The majority of patients who suffer from an early or advanced stage of ovarian cancer complain about symptoms, mainly gastrointestinal

ones. The pelvic examination in ovarian cancer detection is limited by the adnexal position in the pelvis and frequent extraovarian

spread of disease. The evaluation of tumor marker CA 125 is justified only in suspicion of ovarian cancer, and rather is to be used in

the follow up of ovarian cancer patients during oncological treatment. Otherwise the known high false positivity of CA 125 may cause

unnecessary further examinations and invasive intervations. The evaluation of new tumor marker HE4 might be worthy in a selected

group of patients (e.g. with endometriomas etc.), however the HE4 or combination of HE4/CA 125 did not increase the detection of malignant

disease compared with CA 125 alone. Recently, ultrasound is the method of choice in diferential diagnosis between benign and

malignant ovarian tumors. The experienced examiner is also able to detect extraovarian tumor spread and to assess tumor operability.

MRI is used only to complement ultrasound in cases when high tissue resolution is needed. CT is a useful method for detection of extraovarian

spread, especially in cases when an ultrasound examiner experienced in abdominal scanning is not available. Similarly, PET/CT

is a highly accurate method for the detection of abdominal and extraabdominal tumor spread, but its use is limited by cost and the low

availability of this method. On the other hand, PET/CT is not recommended for primary cancer detection because of its lower sensitivity

in comparison to ultrasound and its high false positive rates.

Keywords: ovarian cancer, ultrasound, MRI, CT, PET, pelvic examination, symptom, CA 125, HE4

Published: April 23, 2012  Show citation