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Chapter 093. Gynecologic Malignancies (Part 2)

Screening In contrast to patients who present with advanced disease, patients with early ovarian cancers (stages I and II) are commonly curable with conventional therapy. Thus, effective screening procedures would improve the cure rate in this disease. Although pelvic examination and CA-125 can occasionally detect early disease, these are relatively insensitive screening procedures. Transvaginal sonography is often used, but significant false-positive results are noted, particularly in premenopausal women. Doppler flow imaging coupled with transvaginal ultrasound may improve accuracy and reduce the high rate of false positives. . | Chapter 093. Gynecologic Malignancies Part 2 Screening In contrast to patients who present with advanced disease patients with early ovarian cancers stages I and II are commonly curable with conventional therapy. Thus effective screening procedures would improve the cure rate in this disease. Although pelvic examination and CA-125 can occasionally detect early disease these are relatively insensitive screening procedures. Transvaginal sonography is often used but significant false-positive results are noted particularly in premenopausal women. Doppler flow imaging coupled with transvaginal ultrasound may improve accuracy and reduce the high rate of false positives. CA-125 has significant limitations as a screening test. Half of women with stages I and II ovarian cancer have normal CA-125 levels. Attempts have been made to improve the sensitivity and specificity by combinations of procedures commonly transvaginal ultrasound and CA-125. In a screening study of 22 000 women 42 had a positive screen and 11 had ovarian cancer seven with advanced disease . In addition eight women with a negative screen developed ovarian cancer. Thus the false-positive rate would lead to a large number of unnecessary i.e. negative laparotomies if each positive screen resulted in a surgical exploration. In the United Kingdom a large collaborative screening trial is underway to prospectively compare various screening techniques with controls. Until the results of such trials are available the National Institutes of Health Consensus Conference recommended against screening for ovarian cancer among the general population without known risk factors for the disease. Although no evidence shows that screening saves lives many physicians use annual pelvic examinations transvaginal ultrasound and CA-125 to screen women with a family history of ovarian cancer Lynch type II or breast ovarian cancer syndrome. Proteomic technologies have been used to identify patterns of proteins associated with early