How to correctly diagnose ovarian mass

[K06100]

A 42-year-old postmenopausal woman presents
to the clinic complaining of vague abdominal
pain, early satiety, and a 9-kg (20-lb) unintended
weight loss. She has a history of normal
Pap smears. On physical examination her abdomen
is fi rm, with evidence of ascites and a
fi rm, irregular, and fi xed left adnexal mass palpated
on vaginal examination. CT scan of the
abdomen and pelvis confi rms the presence of
an ovarian mass that has features that are
highly suspicious for cancer. What is the best
means to correctly diagnose and stage this
mass?

(A) Measurement of α-fetoprotein, β-human
chorionic gonadotropin, and lactate dehydrogenase
levels
(B) Measurement of cancer antigen 125 level
(C) MRI of the abdomen and pelvis
(D) Percutaneous needle biopsy of the tumor
for histopathologic staining
(E) Surgical exploration with tumor debulking
and nodal sampling

[Novobiocin]

Originally Posted by K06100

A 42-year-old postmenopausal woman presents
to the clinic complaining of vague abdominal
pain, early satiety, and a 9-kg (20-lb) unintended
weight loss. She has a history of normal
Pap smears. On physical examination her abdomen
is fi rm, with evidence of ascites and a
fi rm, irregular, and fi xed left adnexal mass palpated
on vaginal examination. CT scan of the
abdomen and pelvis confi rms the presence of
an ovarian mass that has features that are
highly suspicious for cancer. What is the best
means to correctly diagnose and stage this
mass?

(A) Measurement of α-fetoprotein, β-human
chorionic gonadotropin, and lactate dehydrogenase
levels
(B) Measurement of cancer antigen 125 level
(C) MRI of the abdomen and pelvis
(D) Percutaneous needle biopsy of the tumor
for histopathologic staining
(E) Surgical exploration with tumor debulking
and nodal sampling

(E) Surgical exploration with tumor debulking and nodal sampling

But the best way is to to do intra-operative frozen section from the mass.

[K06100]

The correct answer is E. To properly stage an
ovarian mass that is highly suspicious for cancer,
a full exploration and inspection of all pelvic
structures is required. There is no noninvasive
means to consistently diagnose and stage
ovarian cancer. Removal of the primary mass
with histopathologic staining is required, and
retroperitoneal exploration with pelvic and
para-aortic nodal sampling is performed.
Answer A is incorrect. Elevated α-fetoprotein,
β-human chorionic gonadotropin, and lactate
dehydrogenase levels are associated with
primary germ cell cancers. Measurements of
these levels are performed in cases in which a
fi rm fi xed adnexal mass is palpated in a premenarchal
or adolescent patient because primary
germ cell cancers are more prevalent in this age
group.
Answer B is incorrect. A work-up for ovarian
cancer should include measuring the CA-125
level because certain cancers can present with
an elevated level. In such instances, response
to chemotherapy can be monitored by the drop
in CA-125. However, cancers other than ovarian
cancer may elevate the CA-125 level (e.g.,
endometrial cancer, certain pancreatic cancers).
Benign conditions, such as endometriosis,
uterine leiomyoma, and pelvic infl ammatory
disease (PID), can elevate the level as well. CA-
125 level assessment play no role in the staging
of ovarian cancer as staging is performed surgically.
Answer C is incorrect. Although MRI will
show the ovarian mass and nodes that are involved,
MRI will not distinguish the type of
ovarian cancer. Tissues from the mass and
nodes are required to diagnose and fully stage
the progression of cancer.
Answer D is incorrect. Although a needle biopsy
will provide tissue to diagnose the mass,
deep pelvic nodes (from which tissue is required
to properly stage the spread of disease) are not
reached by percutaneous needle biopsy.