Fast Five Quiz: Ovarian Cancer

Michel E. Rivlin, MD

Disclosures

September 27, 2018

If a malignant germ cell tumor is suspected at presentation, blood should be examined for tumor markers, including beta human chorionic gonadotropin, alpha-fetoprotein, and lactate dehydrogenase.

MRI can increase the specificity of imaging evaluation in cases of suspected ovarian cancer where the ultrasound appearance of the lesion is indeterminate. MRI is not definitive, however. On MRI, endometriotic cysts with enhanced mural nodules are a hallmark of ovarian cancer, but they may also be a feature of benign neoplasms and even inflammatory diseases.

Fine-needle aspiration or percutaneous biopsy of an adnexal mass is not routinely recommended. In most cases, this approach may only serve to delay diagnosis and treatment of ovarian cancer. Instead, if a clinical suggestion of ovarian cancer is present, the patient should undergo a surgical evaluation for diagnosis and staging.

When imaging studies demonstrate an adnexal mass, the decision whether to observe the patient with repeat imaging or to proceed to surgical evaluation must take into account not only the imaging characteristics but also the patient's medical history, physical examination results, and CA125 level. Tumor markers, such as CA125, are not good discriminators of benign lesions from malignant lesions in premenopausal women but have better accuracy in postmenopausal women.

For more on the workup of ovarian cancer, read here.

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