eMedicine Specialties > Obstetrics and Gynecology > none

Ovarian Cancer: Differential Diagnoses & Workup

Author: Agustin A Garcia, MD, Associate Professor of Medicine, University of Southern California Keck School of Medicine
Contributor Information and Disclosures

Updated: Dec 13, 2007

Differential Diagnoses

Adnexal Tumors
Pancreatic Cancer
Ascites
Rectal Cancer
Borderline Ovarian Cancer
Irritable Bowel Syndrome
Ovarian Cysts

Other Problems to Be Considered

Gastric adenocarcinoma
Malignant gastric tumors
Appendiceal tumors

Workup

Laboratory Studies

  • If ovarian cancer due to a pelvic or ovarian mass is suggested, minimize preoperative testing and expedite a diagnostic and staging laparotomy.
  • Routine preoperative tests include CBC count, chemistry panel (including liver function tests), and a cancer antigen 125 assay (CA-125). Remember that CA-125 may be within normal limits in 50% of women with early ovarian cancer.

Imaging Studies

  • Routine imaging is not required in all patients in whom ovarian cancer is highly suggested.
  • If diagnostic uncertainty is present, a pelvic ultrasound or CT scan of the abdomen and pelvis is warranted.
  • Chest radiographs are common and considered routine.
  • CT scan of the chest is seldom indicated.

Other Tests

  • In patients with diffuse carcinomatosis and GI symptoms, a GI tract workup may be indicated, including one of the following:
    • Upper and/or lower endoscopy
    • Barium enema
    • Upper GI series

Procedures

  • Biopsy
    • A fine-needle aspiration (FNA) or percutaneous biopsy of an adnexal mass is not routinely recommended. In most cases, taking this approach instead of performing a surgical staging laparotomy may only serve to delay appropriate diagnosis and treatment of ovarian cancer.
    • If a clinical suggestion of ovarian cancer is present, the patient should undergo a diagnostic and surgical procedure.
    • An FNA or diagnostic paracentesis should be performed in patients with diffuse carcinomatosis or ascites without an obvious ovarian mass.

Histologic Findings

Epithelial tumors represent the most common histology (90%) of ovarian tumors. Other histologies include (1) low malignant or borderline ovarian tumors, (2) sex cord stromal tumors, (3) germ cell tumors, (4) primary peritoneal carcinoma, and (5) metastatic tumors of the ovary.

Staging

FIGO staging for ovarian cancer is as follows:

  • Stage I - Growth limited to the ovaries
    • Stage Ia - Growth limited to 1 ovary, no ascites, no tumor on external surface, capsule intact
    • Stage Ib - Growth limited to both ovaries, no ascites, no tumor on external surface, capsule intact
    • Stage Ic - Tumor either stage Ia or Ib but with tumor on surface of one or both ovaries, ruptured capsule, ascites with malignant cells or positive peritoneal washings
  • Stage II - Growth involving one or both ovaries, with pelvic extension
    • Stage IIa - Extension and/or metastases to the uterus or tubes
    • Stage IIb - Extension to other pelvic tissues
    • Stage IIc - Stage IIa or IIb but with tumor on surface of one or both ovaries, ruptured capsule, ascites with malignant cells or positive peritoneal washings
  • Stage III - Tumor involving one or both ovaries, with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes; superficial liver metastases equal stage III
    • Stage IIIa - Tumor grossly limited to pelvis, negative lymph nodes but histological proof of microscopic disease on abdominal peritoneal surfaces
    • Stage IIIb - Confirmed implants outside of pelvis in the abdominal peritoneal surface; no implant exceeds 2 cm in diameter and lymph nodes are negative
    • Stage IIIc - Abdominal implants larger than 2 cm in diameter and/or positive lymph nodes
  • Stage IV - Distant metastases; pleural effusion must have a positive cytology to be classified as stage IV; parenchymal liver metastases equals stage IV

More on Ovarian Cancer

Overview: Ovarian Cancer
Differential Diagnoses & Workup: Ovarian Cancer
Treatment & Medication: Ovarian Cancer
Follow-up: Ovarian Cancer
References
[ CLOSE WINDOW ]

References

  1. Hess LM, Benham-Hutchins M, Herzog TJ, Hsu CH, Malone DC, Skrepnek GH. A meta-analysis of the efficacy of intraperitoneal cisplatin for the front-line treatment of ovarian cancer. Int J Gynecol Cancer. May-Jun 2007;17(3):561-70. [Medline].

  2. Elit L, Oliver TK, Covens A, Kwon J, Fung MF, Hirte HW. Intraperitoneal chemotherapy in the first-line treatment of women with stage III epithelial ovarian cancer: a systematic review with metaanalyses. Cancer. Feb 15 2007;109(4):692-702. [Medline].

  3. [Best Evidence] Armstrong DK, Bundy B, Wenzel L, Huang HQ, Baergen R, Lele S. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. Jan 5 2006;354(1):34-43. [Medline].

  4. Alberts DS, Liu PY, Hannigan EV, et al. Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med. Dec 26 1996;335(26):1950-5. [Medline].

  5. Cochrane Database of Systematic Reviews [database online]. John Wiley & Sons, Ltd; Jan 2006.

  6. Garcia AA. Salvage therapy for ovarian cancer. Curr Oncol Rep. Sep 1999;1(1):64-70. [Medline].

  7. Goff BA, Mandel LS, Melancon CH, Muntz HG. Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA. Jun 9 2004;291(22):2705-12. [Medline].

  8. Markman M, Liu PY, Wilczynski S, et al. Phase III randomized trial of 12 versus 3 months of maintenance paclitaxel in patients with advanced ovarian cancer after complete response to platinum and paclitaxel-based chemotherapy: a Southwest Oncology Group and Gynecologic Oncology Group trial. J Clin Oncol. Jul 1 2003;21(13):2460-5. [Medline].

  9. Mazzeo F, Berliere M, Kerger J, et al. Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy in patients with primarily unresectable, advanced-stage ovarian cancer. Gynecol Oncol. Jul 2003;90(1):163-9. [Medline].

  10. McGuire WP, Hoskins WJ, Brady MF, et al. Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Engl J Med. Jan 4 1996;334(1):1-6. [Medline].

  11. NCI Clinical Announcement on Intraperitoneal Chemotherapy in Ovarian Cancer. January 5, 2006: National Cancer Institute; [Full Text].

  12. Ozols RF, Bundy BN, Greer BE, et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol. Sep 1 2003;21(17):3194-200. [Medline].

  13. Parmar MK, Ledermann JA, Colombo N, du Bois A, Delaloye JF, Kristensen GB. Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet. Jun 21 2003;361(9375):2099-106. [Medline].

  14. Pfisterer J, Plante M, Vergote I, du Bois A, Hirte H, Lacave AJ. Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. J Clin Oncol. Oct 10 2006;24(29):4699-707. [Medline].

  15. Rebbeck TR, Lynch HT, Neuhausen SL, Narod SA, Van't Veer L, Garber JE. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med. May 23 2002;346(21):1616-22. [Medline].

  16. Rose PG, Nerenstone S, Brady MF, Clarke-Pearson D, Olt G, Rubin SC. Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med. Dec 9 2004;351(24):2489-97. [Medline].

  17. Sifri R, Gangadharappa S, Acheson LS. Identifying and testing for hereditary susceptibility to common cancers. CA Cancer J Clin. Nov-Dec 2004;54(6):309-26. [Medline].

  18. U.S. Preventive Services Task Force. Screening for ovarian cancer: recommendation statement. U.S. Preventive Services Task Force. Am Fam Physician. Feb 15 2005;71(4):759-62. [Medline].

  19. van der Burg ME, van Lent M, Buyse M, et al. The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecological Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. N Engl J Med. Mar 9 1995;332(10):629-34. [Medline].

  20. Vasey PA, Jayson GC, Gordon A, et al. Phase III randomized trial of docetaxel-carboplatin versus paclitaxel-carboplatin as first-line chemotherapy for ovarian carcinoma. J Natl Cancer Inst. Nov 17 2004;96(22):1682-91. [Medline].

  21. White R, Le Van D, McDuff D. Helping the patient in denial: the role of the family in intervention. Md Med J. Jun 1995;44(6):462-6. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Agustin A Garcia, MD, Associate Professor of Medicine, University of Southern California Keck School of Medicine
Agustin A Garcia, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Karen Loeb Lifford, MD, Director of General Gynecology, Associate Program Director, Department of Obstetrics and Gynecology, Instructor, Brigham and Women's Hospital, Harvard Medical School
Karen Loeb Lifford, MD is a member of the following medical societies: Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Antonio V Sison, MD, Program Director, Department of Obstetrics and Gynecology, Robert Wood Johnson University Hospital
Antonio V Sison, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and Association of Professors of Gynecology and Obstetrics
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Assumption Community Hospital
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Associate Professor, Coordinator, Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.