A 50-year-old woman presents with abdominal fullness, vague abdominal pain, and constipation. She had colonoscopy 7 years ago that was normal. She has a 20-packyear smoking history but quit 10 years ago. She cannot recall any family history of cancer. Pelvic examination reveals left adnexal fullness. Her BMI is 40.
What is the most appropriate next step in the evaluation of this patient?
A. Pelvic ultrasoundAn important consideration in this patient is the possibility of ovarian cancer. Pelvic ultrasound is the first imaging study that should be performed. CA-125 levels are not specific for ovarian cancer, and can be elevated in other conditions such as leiomyoma, endometriosis, pregnancy, and liver disease. If ultrasonography suggests an ovarian mass, a CT scan of abdomen and pelvis would be performed to detect metastatic disease. Pelvic ultrasound is a better first test because it is simpler, cheaper, and does not involve radiation exposure. Debulking surgery and staging is usually done after the imaging studies have been completed. Risk factors for ovarian cancer include advanced age, family and personal history of ovarian cancer, genetics (such as BRCA1 and 2, Lynch type 2 syndrome), obesity, smoking, and nulliparity. Since this patient has several risk factors as well as a finding of adnexal fullness on pelvic examination, reassurance with follow-up may delay appropriate treatment.