A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing) [cachexia; virilization signs (masculinization)]
- Skin and mucous membranes
- Abdominal wall and inguinal region (groin area).
- Auscultation (listening) of the heart.
- Auscultation of the lungs
- Percussion of the abdominal wall (ascites?) [Phenomenon of the fluctuation wave. This can be triggered as follows: if you tap against one flank a wave of fluid is transmitted to the other flank, which can be felt by placing the hand (undulation phenomenon); flank attenuation].
- Palpation of the abdominal wall (soft? depressible?, defensive tension?, tumor palpable?) and the inguinal region (palpable lymph nodes?).
- Inspection (viewing) [cachexia; virilization signs (masculinization)]
- Gynecological examination
- Inspection
- Vulva (external, primary female sexual organs).
- Vagina (vagina)
- Cervix uteri (cervix) or portio (cervix; transition from the cervix (cervix uteri) to the vagina (vagina)), taking a Pap smear (for early detection of cervical cancer).
- Palpation (bimanual; palpation with both hands) of the internal genital organs.
- Cervix uteri (cervix) [vaginal bleeding (bleeding from the vagina); also postmenopausal bleeding]
- Uterus (uterus) [normal: anteflexed/angled forward, normal size, no tenderness; may be indistinguishable from adnexa (tumor growth confined to the lesser pelvis; FIGO II)]
- Adnexa (appendages of the uterus, i.e., the ovary and uterine tube). [Normal: free; evidence of ovarian tumor (with a surface that is smooth, coarse or bumpy, there are all variations) without and with extensive intraperitoneal spread (peritoneal carcinomatosis)]
- Parametria (pelvic connective tissue in front of the cervix to the urinary bladder and on both sides to the lateral pelvic wall) [Normal: free].
- Pelvic walls [Normal: free; metastatic]
- Douglas space (pocket-shaped bulge of the peritoneum (peritoneum) between the rectum (rectum) behind and uterus (uterus) in front) [Normal: free; if necessary, resistances palpable; metastases occur here very early!]
- Palpation of the abdomen (abdomen) [ascites (abdominal dropsy); abdominal tightness; meteorism* ; metastasis to the large mesh and right diaphragmatic dome; possibly metastasis to the liver area (sitting on the surface); metastasis to the inguinal lymph nodes]
- Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation [resistances; possibly also rectal bleeding].
- Inspection of the mammae (breasts), right and left; the nipple (breast), right and left, and the skin [Normal: unremarkable].
- Palpation of the mammae, both supraclavicular pits (upper clavicular pits), and axillae (axillae) [Normal: unremarkable].
- Inspection
- Health check (as an additional follow-up measure).
* In approximately 85% of ovarian cancer patients, typical irritable bowel syndrome symptoms occur before the cancer diagnosis new and as the first symptom! (approx. 6 months before diagnosis).
Square brackets [ ] indicate possible pathologic (pathological) physical findings.