A 65-year-old G3P3 woman presents to the clinic with a 2-month history of progressive abdominal bloating, early satiety, and vague pelvic fullness. Physical examination reveals a firm, irregular, fixed mass in the right adnexa and shifting dullness on abdominal percussion. Arrange the following steps in the most appropriate sequential order for the standard diagnostic evaluation and definitive management of this patient's condition.
- 1Perform transvaginal ultrasonography to characterize the pelvic mass
- 2Obtain a serum CA-125 level for risk stratification
- 3Perform computed tomography (CT) of the abdomen and pelvis
- 4Perform exploratory laparotomy with cytoreductive surgery and comprehensive staging
- 5Administer systemic platinum-based adjuvant chemotherapy
Cevap
The correct sequence is: transvaginal ultrasonography, followed by serum CA-125 measurement, then CT imaging of the abdomen and pelvis, followed by exploratory laparotomy, and finally systemic platinum-based adjuvant chemotherapy.
The standard pathway for a suspected malignant adnexal mass begins with transvaginal ultrasonography to confirm and characterize the lesion. Once high-risk features are identified, a serum CA-125 level is drawn to assist in risk stratification. Before proceeding to the operating room, a CT of the abdomen and pelvis is required to assess for metastases and plan the surgical cytoreduction. Definitive management involves an exploratory laparotomy for surgical staging and maximal tumor debulking, which also provides the tissue diagnosis, followed by systemic platinum-based chemotherapy.
Adım Adım Çözüm
Anahtar Kavram
The sequential evaluation and standard management pathway for suspected advanced epithelial ovarian cancer.