Dear OncoLink "Ask The Experts,"
I am a predominately healthy 37 year old woman with two children, no recent birth control pill use and had a grandmother die with colon cancer. I've been scheduled for laparoscopy to remove a tumor on my left ovary described as being a solid mass with cell walls and internal structures measuring 3.2cm. My CA125 level was 2.3 (results weren't measured by u/ml). I've read that laparotomy is more commonly performed for surgical treatment of suspected malignancies and additional exploratory evaluation of other reproductive organs.
I'm waiting for answers to several questions from the gynecologist scheduled to perform the surgery, have an appointment for a 2nd opinion from another gynecologist, but am concerned that I may need to find a oncologist specializing in gynecological surgery. Would you recommend a specific course of action using a particular type of medical practitioner?
Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System, responds:
Prior to operating on a patient with an ovarian mass, a gynecologist should be able to make a rough estimate of the risk of malignancy, based on such things as the patient's age and family history, the size and appearance of the mass on scan, and the CA 125 level. If there is a significant risk of cancer, the procedure should be done by a gynecologic cancer surgeon, who will make a decision as to whether or not laparoscopy is appropriate. Most gynecologic oncologists prefer to perform open surgery (laparotomy) when the risk of ovarian cancer is high. If you have any questions or concerns, a second opinion from a gynecologic oncologist may be appropriate.
Sep 10, 2010 - A novel assay that uses serum HE4 and CA125 to predict epithelial ovarian cancer in women with pelvic masses appears to have a significantly higher sensitivity than the Risk of Malignancy Index, according to research published in the September issue of the American Journal of Obstetrics & Gynecology.
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