Evaluation of Ovarian Disease

EVALUATION OF OVARIAN DISEASE

A thorough pelvic examination is essential for evaluation of the ovary. Symptoms that may arise from physiologic and pathologic processes of the ovary must be correlated with physical examination findings. Also, because some ovarian conditions are asymptomatic, incidental physical examina-tion findings may be the only information available when an evaluation begins. Interpretation of examination find-ings requires knowledge of the physical characteristics of the ovary during the stages of the life cycle.

In the premenarchal age group, the ovary should not be palpable.

If it is, a pathologic condition is presumed, and further eval-uation is necessary.

In the reproductive-age group, the normal ovary is palpable about half the time. Important considerations includeovarian size, shape, consistency (firm or cystic), and mobil-ity. In reproductive-age women taking oral contracep-tives, the ovaries are palpable less frequently and are smaller and more symmetric than in women who are not using contraceptives.

In postmenopausal women, the ovaries are less respon-sive to gonadotropin secretion; therefore, their surface fol-licular activity diminishes over time, disappearing in most women within 3 years of the onset of natural menopause. Perimenopausal women are more likely to have residual functional cysts. In general, palpable ovarian enlargement in postmenopausal women should be assessed more criti-cally than in a younger woman, because the incidence of ovarian malignant neoplasm is increased in this group.

One-quarter of all ovarian tumors in postmenopausal women are malignant, whereas in reproductive-age women only about 10% of ovarian tumors are malignant. This risk was consid-ered so great in the past that any ovarian enlargement in a postmenopausal woman was an indication for surgical investigation, the so-called palpable postmenopausal ovary (PPO) syndrome. With the advent of more sensitive pelvic imaging techniques to assist in diagnosis, routine removal of minimally enlarged postmenopausal ovaries is no longer recommended.

CA-125 is a serum marker used to distinguish benign from malignant pelvic masses. Tumors can be evaluated by CA-125 assessments and ultrasound as well as consid-eration of family history. Simple, unilocular cysts less than 10 cm wide confirmed by transvaginal ultrasonography, are almost universally benign and may safely be followed with-out intervention regardless of age. Any CA-125 elevation in a postmenopausal woman with a pelvic mass is highly suspicious for cancer.