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Re: Solid ovarian massFrom: Anthony Evans (ahcevans@execpc.com)Mon Mar 29 12:34:13 1999
On Sat, 27 Mar 1999 10:08:26 -0600, Lynne Loeffler <midwife@moment.net> wrote:
> (1) Any reasonable possibility this is NOT ovarian cancer? What Yes, there is a distinct possibility. Dermoids, mucinous cystadenomas, fibromas, etc.
> (2) Laparotomy, not laparoscopy, would be done always in this In the absence of other data, I would start with a scope --> If excrescences or gross cancer --> laparotomy and staging; If grossly benign --> LAVH, BSO with staging if indicated by frozen section.
> (3) Would you go ahead and do CA 125, or is it really any help here? I always get a CA125 preop in this type of situation. If normal, the woman has less anxiety and can expect a benign course in many cases. If elevated, she can prepare for the likelihood that it is cancer BEFORE surgery rather than deal with the issues of recovery from surgery and diagnosis of cancer simultaneously. I think it also helps triage those who need referral. The higher the CA125, the higher the risk of malignancy (even in pre-menopausal patients). For post-menopausal women, CA125 > 50 to 65 is associated with malignancy 80 to 90% of the time. In pre-menopausal women, normal CA125 in the face of sonographic features suggestive of malignancy is associated with cancer about 50% of the time. An elevated CA125 in such a setting would be very suggestive of cancer. (See Chapter 7, "Tumor Markers", by Evans and Berchuck in Principles and Practice of Gynecologic Oncology)
> (4) Would you be more worried if you knew her sister (also in her Not in the absence of any other significant family history of cancer. If your patient turns out to have cancer, a more extensive genetic pedigree and investigation of familial tendencies would be in order. Hope this helps, Craig Evans, M.D., Ph.D. Vince Lombardi Cancer Clinic Milwaukee, WI
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