Chief Complaint: Ovarian Mass
The workup for an ovarian mass typically involves several steps:
## Initial Evaluation
- A thorough medical history and physical examination, including a pelvic exam, should be performed to assess for risk factors and symptoms[1].
- The pelvic exam can help evaluate the size, tenderness, location, and mobility of any adnexal masses[1].
## Imaging
- Transvaginal ultrasonography (TVUS) is the preferred initial imaging modality for evaluating adnexal masses[1][2]. It can assess:
- Size and composition (cystic, solid, or mixed)
- Presence of septations, mural nodules, or papillary excrescences
- Free fluid in the pelvis
- For larger masses, both transvaginal and transabdominal approaches may be used[2].
## Laboratory Tests
- CA-125 blood test:
- Should be drawn in postmenopausal patients with adnexal masses[1]
- Not routinely recommended for premenopausal patients during initial workup[1]
- Other blood tests may include:
- Complete blood count
- Kidney and liver function tests
- Additional tumor markers in certain cases (e.g., AFP, beta-hCG for younger patients)[3]
## Further Imaging
If initial evaluation is inconclusive or suggests malignancy:
- CT scan of the chest, abdomen, and pelvis may be performed to assess for metastasis[1][3]
- MRI can be useful as a second-line imaging option for characterizing indeterminate ovarian cysts[2]
## Biopsy
- A biopsy is the only definitive way to diagnose ovarian cancer[3]
- Often performed during surgery (laparotomy or laparoscopy)
- Image-guided biopsy may be an option in some cases[3]
## Specialist Referral
- Patients with suspicious findings should be referred to a gynecologic oncologist for further management[2]
The specific workup may vary based on the patient's age, menopausal status, and initial findings. The goal is to differentiate between benign and potentially malignant masses to guide appropriate management.
Citations:
[1] https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10316833/
[3] https://www.cancerresearchuk.org/about-cancer/ovarian-cancer/getting-diagnosed/tests-ovarian-cancer
[4] https://www.cancer.org/cancer/types/ovarian-cancer/detection-diagnosis-staging/how-diagnosed.html
[5] https://www.cancer.org/cancer/types/ovarian-cancer/detection-diagnosis-staging/detection.html
[6] https://emedicine.medscape.com/article/258044-workup
a. Abdominal X-Ray: Calcifications in the mass
Differential Diagnosis