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DiagnosisThe typical age of diagnosis is 63In early disease; physical findings are uncommon. Patients with more advanced disease may present with an ovarian or abdominal mass, pleural effusion (by auscultation), ascites or bowel obstruction (Golata). Blood tests are also done to identify certain tumor markers that are specific for ovarian cancer by the use of immunohistochemistry. The tumor markers are; CA125, beta-human chorionic gonatropin, alpha-fetoprotein, lactate dehydrogenase. Tumor markers are useful in screening, determining diagnosis and prognosis, assessing response to therapy and monitoring for cancer recurrence.
OVARIAN CANCER 4The latter two markers are tested in young girls suspected to have malignant germ cell tumors. Urinalysis can also be done to exclude other causes of abdominal/pelvic pain, such as urinary tract infections or kidney stones.A pelvic examination may reveal an adnexal mass that can indicate ovarian cancer, mainly if it is fixed, nodular and irregular malignancies cause about 20% of the adnexal masses. Breast examination and digital rectal exam can also be helpful especially in cases of metastases. Palpation of supraclavicular (lung cancer), axillary (breast cancer) and inguinal lymph nodes can show lymphadenopathy that could indicate metastasis.Imaging is also done especially CT scanning and MRI to assess further the extent of the tumor in the abdomen. Vaginal ultrasonography (most useful initial investigation) is performed after an adnexal mass is found; it may define the morphology of the pelvic tumor. Chest x rays and CT help in excluding pleural effusions or pulmonary spread of malignant disease of the ovary.A definitive diagnosis of the ovarian cancer is done after surgery and can either be laparotomy (open procedure) or laparoscopy (keyhole surgery- non-invasive). After the surgery, a biopsy of the cancerous tissue is taken for histopathology analysis that helps classify cancer and also staging. Fine needle aspiration or diagnostic paracentesis can also be performed in patients with abdominal fluid to identify cancerous cells and help in staging, in case of absence of obvious ovarian masses.In the case of gastrointestinal symptoms, a full gastrointestinal workup could be done, particularly an endoscopy or a barium enema. In the case of ascites, abdominal fluid aspiration
OVARIAN CANCER 5could be done to check for metastases to other abdominal organs.ManagementOvarian cancer usually has a poor prognosis because it lacks any clear early detection or screening test and most diagnoses are made when cancer it at advanced stages. It metastasizes in the early stages before even its diagnosis. One year survival rate is 72%.