Various imaging techniques can be used to help rule out, diagnose, stage or monitor treatment for ovarian cancer, and making sense of them all can be an onerous task even for the most educated patient. Below is a basic guide to the different scans that may be used, and some of their findings that may raise suspicion for malignancy or put you at ease.
Making Sense of Ultrasound Findings
A pelvic ultrasound, which uses sound waves, is often the scan that is first used to evaluate or find an ovarian mass or tumor. Remember, tumors can be benign or malignant, so the term “tumor” only means an enlargement. What it is can’t be proven until it is removed and evaluated by a pathologist, if that is required.
If you are concerned about ovarian cancer, it is important to remember that the malignancy risk for epithelial cancer of the ovary (the most common ovarian cancer) rises with age, while the much less common germ cell or sex-cord stromal tumors can occur in the second, third and fourth decades of life.
The first language to look for is whether or not the ovarian mass or enlargement is a “simple cyst” or “complex”. Simple cysts are rarely malignant, especially if they are small. Next, if it is described as being complex, is there language which further describes what the complexity is? If it is complex because it has a “septum,” which is only a separation between several parts of a cyst, it is less likely to be malignant or cancerous. If the complexity is noted to contain nodules or “excresences” or multiple solid parts, then it is more likely to be something to be concerned about.
Next, what is the size of the mass? Although there are no clear cut-off points, simple cysts that are less than 10 centimeters (size of an orange) are unlikely to be malignant.
Finally, is there any mention of “free fluid” in the pelvis? This may mean that there is “ascites” which is part of the ovarian cancer growth process. It does not prove that you have cancer, and a small amount can be a normal finding, but a lot of free fluid or “ascites” is more worrisome.
Understanding CT or CAT Scan Findings
Computed tomography is a fancy scan which uses computers to create and record absorption rates of X-ray beams in tissue and bone. These scans are used to take a closer look at whether or not cancer has spread to other areas such as lymph nodes, around the intestines,in the liver, or lungs.
Terms to look for that might signify spread of cancer include the following: ascites, metastases, carcinomatosis, lesions, omental cake, stranding, and effusion. Also, lymph nodes may be described as enlarged. The closer they are to 2 centimeters or larger, especially with “central necrosis”, the more it may represent cancer spread.
Keep in mind that scans are merely sound or X-ray shadows. They cannot absolutely diagnose, prove or disprove that you have cancer. For that a biopsy is required. When ovarian cancer is suspected, usually surgery is the next step. Needle biopsies guided by ultrasound or CAT scan are usually only performed when it is obvious that there is spread. An ovarian mass which may represent an early ovarian cancer should not be needle biopsied for fear of rupturing and spreading cancer cells.
If the CAT scans are being used to see if the cancer treatment is working, the terms described above are still the ones to look for. The key is to look for language which describes whether or not the areas of concern are getting smaller or larger. Also, look for specific language like “resolution”, “regression” or “progression” at the end of the report which may signify whether not not things are getting better or worse.
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