Ovarian cancer ascites

Mass screening for ovarian carcinoma appears to be viable using a transvaginal ultrasonography exam that takes only 30 seconds per patient, according to Dr. Shigemi Sato and associates at Hirosaki (Japan) University.

More than 183,000 screening exams were performed in their 10-year study of such a program, and 77.3% of the primary ovarian cancers detected were stage I tumors. All of these women were alive and well with no evidence of recurrence at the most recent follow-up, "a finding we believe was a result of screening," the researchers noted (Cancer 89[3]:56-61, 2000).

Before the screening program was begun, 56% of all ovarian cancers detected at their institution were stage III and IV disease. After the screening program was instituted, 59% of all cases were classified as stage I disease, Dr. Sato and associates said.

The incidence of ovarian cancer in Japan is considerably lower than that in the United States and Europe, the investigators added.

The program involved 24,950 premenopausal and 26,600 postmenopausal women who were already undergoing routine screening for cervical cancer. Primary screening included a Pap smear and a bimanual pelvic exam followed by transvaginal sonography, all of which required an average of 1 minute. The transvaginal scanning alone required 30 seconds per patient.

Secondary screening was considered necessary if a mass of at least 30 mm in length was noted anywhere in the pelvic cavity, if a mass of any size showed a mixed echographic pattern, and/or if ascites measuring 50 mm or more were detected in the rectouterine pouch.

In such cases, a second transvaginal ultrasound study was done and tumor markers were measured, including CA 125, CA 19-9, carcinoembryonic antigen, alpha-fetoprotein, and lactate dehydrogenase fraction.

If the second ultrasound also was suspicious or if any tumor markers were positive, closer examination with CT or MRI and repeat tumor marker testing were done. This cautious approach was taken to minimize the number of false-negative diagnoses, the researchers said.

More than 4,000 women underwent the secondary screening, and 2,554 of them required the closer radiologic examination. A total of 324 women underwent laparotomy for excision of a pelvic mass. Twenty-two of these proved to be primary and two to be metastatic ovarian carcinomas. The remainder were benign ovarian lesions such as dermoid cysts, cystadenomas, and endometrial cysts.

Seventeen of the primary tumors (77.3%) were classified as stage I disease. Tumor markers were positive in only 5 of these, and only 11 of the 22 primary tumors had been palpable on pelvic exam.

A family history of breast, endometrial, or pancreatic cancer greatly increased the risk for ovarian cancer, as did obesity infertility and age over 50 years. All the women with ovarian carcinoma in this study had at least one of these risk factors, Dr. Sato and associates said.

This screening program yielded no false-positive results, they added.