Mandatory medical device diagnostics.
- Vaginal sonography (transvaginal sonography; ultrasound examination by means of an ultrasound probe inserted into the vagina), if necessary also an abdominal sonography – for basic diagnostics [see below checklist for differentiation of ovarian cancer and benign masses].
- X-ray of the thorax (X-ray thorax / chest), in two planes, or lungs – for staging.
Currently, there is no safe apparative diagnostic measure for suspected or disease of ovarian cancer. A clarification and the extent can ultimately be provided only by surgical staging and histology (fine tissue examination). Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic clarification.
- Colonic contrast enema – for suspected involvement of the colon (large intestine).
- Computed tomography (CT) of the pelvis (pelvic CT) – for more accurate diagnosis of targeted issues.
- Magnetic resonance imaging of the pelvis (pelvic MRI) – for more accurate diagnosis in targeted questions.
- Skeletal scintigraphy (nuclear medicine procedure that can represent functional changes in the skeletal system, in which regionally (locally) pathologically (pathologically) increased or decreased bone remodeling processes are present) – for suspected bone metastases.
- Cystoscopy (urinary bladder endoscopy) – if involvement of the urinary bladder is suspected.
- Sigmoidoscopy (rectosigmoidoscopy, i.e., mirroring of the lower approx. 30-40 cm of the rectum (rectum) and the sigmoid colon (sigmoid loop, sigmoid colon)) – if involvement of the colon is suspected.
- I.v. pyelogram (synonyms: IVP; i.v. urogram; urogram; i.v. urography; excretory urography; excretory pyelogram; intravenous excretory urogram; radiographic imaging of the urinary organs or urinary tract system).
“Simple Rules” checklist for differentiating ovarian cancer from benign space-occupying lesions
The majority of ovarian cancers develop in cysts, but most of these cysts are benign. The following are features that can be used to classify the mass as “malignant,” “benign,” or “equivocal”: 5 M features suggestive of carcinoma and 5 B features suggestive of a benign cyst.
| M features [indicative of carcinoma]. | B features [evidence for a benign cyst] |
| irregular solid tumor | unilocular (single chamber) cyst |
| Ascites (abdominal dropsy, is a pathological accumulation of fluid in the free abdominal cavity) | Presence of solid components, which must not exceed 7 mm in largest diameter |
| At least four papillary structures | Occurrence of acoustic shadows |
| Irregular multilocular solid tumor with a largest diameter of at least 100 mm | smooth multilocular (multichambered) tumor with a largest diameter of less than 100 mm |
| Very high percentage of color in the color Doppler examination | Absence of blood flow in the Doppler examination |
The mathematical model achieved a diagnostic accuracy of 98% for distinguishing ovarian cancer from benign space-occupying lesions; a negative predictive value of 98.9% was obtained for a low risk of less than 1%. In women with an estimated risk of 30%, the negative predictive value was 93.95. Ovarian cysts and their cancer risk
- A simple ovarian cyst on ultrasound represents a normal finding; occurrence in 23.8% of women younger than 50 years and in 13.4% of older women examined; simple ovarian cyst does not represent a malignancy (cancer) risk.
- The presence of a complex cyst and solid mass (local circumscribed increase in endogenous tissue) on ultrasound carries a significant risk of carcinomatosis.
