Transvaginal ultrasound: A tool for early diagnosis of ovarian cancer

Pelvic examination combined with transvaginal ultrasound can help detect ovarian cancer risk and lead to better health outcomes for patients.

Ovarian cancer is the second most common gynecologic cancer in the U.S, behind uterine cancer, and the fifth most common cause of cancer death. New screening methods could help catch ovarian cancer earlier and save lives in the process. Here, Justin W. Gorski, M.D., Ph.D., a gynecologic oncologist practicing at Norton Cancer Institute – St. Matthews, answers questions about ovarian cancer.

Why is ovarian cancer so deadly?

One of the major issues with successfully treating ovarian cancer is how late it is typically diagnosed: stage 3C. At that point, the cancer has spread throughout the abdomen. Typically, it also has spread throughout the omentum, or the tissue that surrounds the abdominal organs.

As with many cancers, the five-year survival for ovarian cancer drops when it is diagnosed later. Caught at an early stage, the five-year survival rate is 70% to 90%. Caught late, the five-year survival rate drops to 20% to 30%.

Norton Cancer Institute is a leading provider of gynecologic cancer care.

Who is at risk for ovarian cancer?

While there is no way to know for sure if someone is going to get ovarian cancer, there are some risk factors that may contribute to the onset of the disease, including:

  • Being middle-aged or older
  • Having close family members (such as your mother, sister, aunt or grandmother) on either your mother’s or your father’s side, who have had ovarian cancer
  • Having a genetic mutation (change) called BRCA1 or BRCA2, or one associated with Lynch syndrome
  • Having had breast, uterine or colorectal (colon) cancer
  • Having an Eastern European or Ashkenazi Jewish background
  • Have or have had endometriosis (a condition where tissue from the lining of the uterus grows elsewhere in the body)
  • Having never given birth or have had trouble getting pregnant

There are other indicators of risk. Transvaginal ultrasound (TVUS) can show free fluid in the abdomen. Free fluid can be a sign of ascites, which is a typical symptom of advanced ovarian cancer.

How is ovarian cancer diagnosed?

The two tests used most often (in addition to a complete pelvic exam) to screen for ovarian cancer are TVUS and the CA-125 blood test.

TVUS uses sound waves to look at the uterus, fallopian tubes and ovaries by putting an ultrasound wand into the vagina. TVUS can see if there is a tumor or growth in the ovary, but there is no way to tell if the tumor is cancer or is benign (noncancerous), and can lead to a false positive.

The CA-125 blood test measures the amount of a protein called CA-125 in the blood. Many women with ovarian cancer have high levels of CA-125. This test can be useful in guiding treatment in women known to have ovarian cancer, because a high level of this protein often goes down if treatment is working. The drawback of this test is that there are other conditions that cause high CA-125, such as endometriosis, liver cirrhosis or pelvic inflammatory disease.

How is ovarian cancer treated?

Standard treatment is a combination of debulking surgery and chemotherapy. “Debulking” means removing as much cancer as possible, including removal of the ovaries, uterus, cervix, fallopian tubes, omentum, lymph nodes and any other tissues that may be cancerous. Surgery is paired with six rounds of chemotherapy. The disease usually responds well initially, but the cancer will recur in more than 80% of these cases. 

Using transvaginal ultrasound screening for ovarian cancer

Since 1987, the UK Markey Cancer Center Ovarian Cancer Screening Program has been screening women for signs of early ovarian cancer using transvaginal ultrasound. All women over 50 with no symptoms and women over 25 with no symptoms and a family history of ovarian cancer are eligible. 

Results of the screening trial showed that about 70% of women had benign growths or a very low risk for cancer. The key to accurate diagnosis lies in the other 30%.

The diagnostic accuracy of TVUS is improving, however, thanks to the Kentucky Morphology Index scoring system. The system uses the size and shape of the tumor to give a score ranging from 0 to 10. 

For those patients whose screening score is moderate or high, one important management option for OB/GYNs is to take a series of ultrasounds, repeated at one- to three-month intervals, to see if the growth is changing. If there is change over time, even if the risk is intermediate, then there’s a higher likelihood the cyst needs to be removed surgically. If it stays the same or becomes smaller, usually nothing needs to be done right away, and the cyst can be observed over time. 

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