Screening for ovarian malignancy

Throughout this text we have stated that ultrasound should only be used if a patient is symptomatic due to the high incidence of incidental findings in asymptomatic women. The one where this doesn't apply is screening for ovarian malignancy.

Malignant ovarian tumours are the most common cause of gynaecological cancer related deaths in the Western Europe; 4000 deaths occur every year in the UK from ovarian cancer. Transvaginal ultrasound is fundamental to any screening programme either as a single modality or in conjunction with serum tumour markers. An ovarian volume over 20 cm3 in pre-menopausal women and 10 cm3 in post-menopausal women is considered abnormal. The use of ultrasound screening for ovarian cancer is discussed in Chapter 55.

With continuing advances in technology, it is unlikely that the use of ultrasound as a diagnostic tool has reached its full potential. Further advances are eagerly awaited by most practitioners. However, one must always remember that ultrasound is an adjunct to and not a replacement for a good clinical history and examination. The normal appearance of pelvic organs alters throughout reproductive life under the influence of hormonal regulation. It can also be influenced by exogenous hormones such as hormone replacement theory (HRT) or the oral contraceptive pill. This information is therefore required for accurate interpretation of ultrasound images.

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