How many tests are needed to diagnose ovarian tumors?

Ovarian tumors are common gynecological tumors, accounting for about 1/3 of female genital tumors. They can occur at any age, but are more common in women of childbearing age. Although the incidence of ovarian malignant tumors ranks third among female genital malignant tumors, it is difficult to diagnose early and is often discovered in the late stage. Its mortality rate is the highest among gynecological malignant tumors.

1. Symptoms

(1) Abdominal discomfort Medium-sized benign tumors or rapidly growing malignant tumors often cause abdominal distension and discomfort.

(2) Benign abdominal masses grow slowly and are difficult to detect, so patients often touch them accidentally. Malignant tumors grow quickly and are easy to detect.

(3) Abdominal pain: Benign tumors may cause abdominal pain of varying degrees if they are complicated by torsion, rupture, bleeding, or infection. Malignant tumors may cause abdominal pain, back pain, or lower limb pain if they infiltrate the surrounding area or compress nerves.

(4) Compression symptoms: A large tumor that fills the pelvic cavity may cause compression symptoms such as frequent urination, dysuria, constipation, shortness of breath, palpitations, etc.

(5) Uterine disorders and endocrine symptoms When tumors produce steroid hormones or destroy both ovaries, it can cause menstrual disorders or abnormal uterine bleeding. Granulosa cell tumors and theca cell tumors can produce too much estrogen and cause precocious puberty or postmenopausal uterine bleeding. Testicular blastoma can produce too much androgen and cause masculinization.

(6) Manifestations of metastatic lesions, such as hemoptysis and dyspnea caused by lung metastasis; changes in stool, blood in stool, intestinal obstruction, etc. caused by intestinal metastasis.

2. Physical signs

Benign ovarian tumors are mostly unilateral and located next to the uterus. They are spherical, cystic or solid masses with smooth surfaces, mobility, and clear boundaries from the uterus. Malignant ovarian tumors are bilateral, solid or partially solid masses with uneven surfaces and relatively fixed masses. There may be scattered nodules in the rectouterine pouch.

3. Auxiliary examination

(1) Ultrasound examination B-ultrasound imaging can detect the location, size, shape and nature of the tumor.

(2) Radiological diagnosis: Barium meal or barium enema, air contrast radiography can determine whether there is a tumor in the digestive tract. CT examination can locate and characterize pelvic tumors, and determine whether there is metastasis to the liver, lungs, and retroperitoneal lymph nodes. Pelvic lymph node radiography can determine whether ovarian tumors have lymphatic metastasis.

(3) Laparoscopy can directly observe the origin and general condition of the tumor, as well as the entire pelvic and abdominal cavity and diaphragm, to determine the extent and stage of the lesion. It can also aspirate ascites for cytological examination or take suspicious tissue for pathological examination. However, it is contraindicated for large masses or adhesion masses.

(4) Cytological examination: Cytological examination of ascites obtained by abdominal or posterior fornix puncture is helpful in the diagnosis of ovarian malignant tumors.

(5) Tumor marker examination: The alpha-fetoprotein (aFP) concentration is high in patients with embryonal carcinoma and endodermal sinus carcinoma. AFP greater than 20 μg/L is considered positive. β-hCG determination has diagnostic value for primary ovarian choriocarcinoma and ovarian germ cells mixed with choriocarcinoma components. Cancer antigen CA125 radioimmunoassay (CA125 greater than 65 U/ml is positive) has a high diagnostic significance for epithelial cancer. Lactate dehydrogenase (LDH) determination is helpful for the diagnosis of dysgerminoma.

(6) Enlarged ovaries found during laparotomy before puberty, and ovaries that can still be palpated after menopause; ovarian cystic tumors in women of childbearing age with a diameter greater than 6 cm that do not shrink or increase in size after 3 to 6 months of observation; solid tumors with a diameter greater than 4 cm; ovarian masses found in early pregnancy that do not shrink after 4 months of pregnancy are all indications for laparotomy.