A 66-year-old postmenopausal woman presents to the clinic with a 2-month history of progressive abdominal bloating, early satiety, and vague pelvic pressure. She has no history of abnormal vaginal bleeding. Physical examination reveals a distended abdomen with shifting dullness, and a palpable, firm, irregular right adnexal mass. Arrange the following steps in the most appropriate sequential order for the evaluation and management of this patient, from the initial step to definitive post-surgical treatment.
- 1Perform transvaginal ultrasonography
- 2Measure serum CA-125 levels
- 3Obtain a CT scan of the abdomen and pelvis
- 4Perform an exploratory laparotomy for surgical staging
- 5Administer intravenous platinum-based chemotherapy
Cevap
The correct sequential order is: 1) Transvaginal ultrasonography, 2) Serum CA-125 levels, 3) CT scan of the abdomen and pelvis, 4) Exploratory laparotomy, and 5) Adjuvant platinum-based chemotherapy.
The evaluation of a suspected ovarian malignancy follows a step-wise clinical pathway. Initially, transvaginal ultrasonography is required to confirm the presence and character of the adnexal mass. Once complex features are visualized, a serum CA-125 level is drawn to risk-stratify the postmenopausal patient. With a high index of suspicion established, cross-sectional imaging (CT of the abdomen and pelvis) is performed to assess for distant metastasis and plan for surgery. The primary definitive management is an exploratory laparotomy for staging and cytoreduction (tumor debulking). Finally, because ovarian cancer typically presents at an advanced stage, patients receive postoperative adjuvant platinum-based chemotherapy.
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Anahtar Kavram
Evaluation and management sequence for suspected advanced epithelial ovarian cancer