Clinical Investigations

Serum CA-125 measurements: an increase in serum CA-125 may be an indicator of ovarian malignancy. However, modest or even marked elevation of serum CA-125 may occur in many non-neoplastic diseases or non-ovarian neoplastic diseases, this serum marker being relatively non-specific. CA-125 is produced by mesothelial cells, and conditions which involve the peritoneal cavity with its lining of mesothelial cells are especially liable to result in an elevated serum CA-125. These conditions include ascites, endometriosis, peritoneal tuberculosis and disseminated non-ovarian neoplasms.

Abdominal USS and CT scan: in cases of ovarian neoplasia abdominal USS or CT scan often shows a complex ovarian mass with alternating solid and cystic areas. There may be coexistent ascites and an omental cake, indicating omental involvement by tumour. Unilocular or multi-

locular thin-walled cystic lesions often indicate benign neoplasms. CT scanning is often performed to stage ovarian neoplasia.

Peritoneal aspiration: aspiration of ascitic fluid and cytological examination may be performed in the investigation of ovarian neoplasia.

Laparoscopy: this may be indicated in certain conditions, e.g., suspected endometriosis. Biopsy can be performed at laparoscopy.

In patients with suspected ovarian neoplasia, a risk-malignancy index is calculated. This is a means of assessing the likelihood that an ovarian mass is malignant and takes into account the menopausal status (pre or post menopausal) of the patient, the ultrasound findings and the serum CA-125 measurement.

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