From the Guidelines
The workup for ovarian cancer should include a detailed history and clinical examination, serum CA-125, transabdominal and transvaginal US, and CT of thorax, abdomen, and pelvis, as recommended by the most recent guidelines 1. The initial step in the workup for ovarian cancer involves a thorough history and physical examination to identify symptoms such as abdominal bloating, pelvic pain, difficulty eating, and urinary urgency.
- Initial testing should include:
- Serum CA-125, a tumor marker often elevated in ovarian cancer, although it is not specific to ovarian cancer and may be elevated in non-gynaecological malignancies and benign conditions 1.
- Transabdominal and transvaginal ultrasound (US) by an expert examiner to visualize the ovaries and assess for any abnormalities.
- Computed tomography (CT) of the thorax, abdomen, and pelvis to complete clinical staging and aid surgical planning.
- Additional tests may be necessary, such as:
- Serum CEA and CA 19-9, in the case of mucinous carcinoma, and endoscopy, if either or both are elevated, to distinguish primary mucinous ovarian tumors from a gastrointestinal metastasis 1.
- Pathological examination of adequate tumor sample from diagnostic biopsy or surgical specimen to confirm the diagnosis.
- Cytological assessment of pleural effusion if present to complete staging. The definitive diagnosis of ovarian cancer requires pathological examination by an expert pathologist of tumor samples from either a diagnostic biopsy or, preferably, a surgical specimen 1.
- The workup should also include genetic testing for BRCA1/BRCA2 mutations, as these mutations significantly increase risk and may guide treatment decisions.
- A comprehensive approach is necessary because ovarian cancer is often diagnosed at advanced stages due to vague early symptoms and the lack of effective screening methods for the general population.
- The US-based diagnostic models, such as the International Ovarian Tumor Analysis (IOTA) Simple Rules risk model or IOTA Assessment of Different NEoplasias in the adneXa (ADNEX) model, are preferable to CA-125, the human epididymis protein 4 (HE4), or the Risk of Ovarian Malignancy Algorithm, as they are superior in distinguishing between benign and malignant ovarian tumors 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Workup for Ovarian Cancer
The workup for ovarian cancer typically involves a combination of physical examination, imaging tests, and biomarker measurements.
- Physical examination: A thorough physical examination is essential to identify any abnormalities in the pelvic area 2.
- Imaging tests: Transvaginal ultrasonography is commonly used to evaluate the ovaries and detect any masses or abnormalities 2, 3.
- Biomarker measurements: Cancer antigen 125 (CA-125) is a commonly used biomarker to detect ovarian cancer, although it is not specific to the disease 2, 3, 4.
Diagnostic Evaluation
The diagnostic evaluation of ovarian cancer may also involve:
- Symptom assessment: Evaluating symptoms such as abdominal pain, bloating, and pelvic pressure 3.
- Family history: Assessing family history of ovarian and breast cancer to identify potential genetic risk factors 2, 5.
- Additional imaging: CT scans, PET scans, and MRI may be used to further evaluate the extent of the disease and guide treatment decisions 3, 4.
Presurgical Workup
A presurgical workup is essential to determine the extent of the disease and guide treatment decisions.