**7.9. Pelvic examination**

It has been advocated that routine pelvic examination should be part of the screening process for ovarian cancers but non-randomized control trial has assessed the role of the bimanual pelvic examination for ovarian cancer screening. In the PLCO cancer trials no case of ovarian cancer was ovarian cancer was identified solely by bimanual examination (USPTF 2012) The American cancer society had advocated pelvic examination for asymptomatic women as one of the methods of screening for ovarian cancer in combination with other screening methods like CA 125 and transvaginal ultrasound scan (ACS 2012).

#### **7.10. Use of ultrasonography**

The measurement of the volume of the ovaries has being used in screening of ovarian cancer. Transvaginal ultrasound scan can detect changes in the ovarian size and morphology. The upper limit of ovarian size for premenopausal women was 20cm3 and 10cm3 for postmeno‐ pausal women (Parlik EJ et al). Adding the parameters of cyst wall, characteristics and septation increases the sensitivity to 86% and a specificity of 99% for differentiating benign from malignant lesions(Depriest et al). It is however not recommended for population screening because of its low predictive value and lack of specificity. The combination of colour flow Doppler with transvaginal scan may assist in distinguishing malignant from benign lesions by measurement of the vascular resistance pattern of blood vessels supplying the ovaries

A combination of ultrasound scan, CA125 and menopausal status can be used in calculating the risk of malignancy index for patients and may buttress the need for more vigilance. The risk of malignancy index of greater than 200 connotes a higher risk of malignancy.

RMI=M x C x U (RCOG guideline,2003) where

M: Score of 1=premenopausal, 3=postmenopausal

C: value of the CA125

U: 1=normal scan

1 for each of the following presence of multilocular, bilateral,solid components ascities and metastatic disease with a maximum score of 3

#### **7.11. Laparoscopy**

**7.8. Proteomic technology**

136 Contemporary Gynecologic Practice

**7.9. Pelvic examination**

**7.10. Use of ultrasonography**

et al 2013).

ovaries

C: value of the CA125

U: 1=normal scan

This enables analysis of cluster patterns produced based on the size and net electrical charge of serum proteins produced by the various tumours. The proteome represents all the possible gene products of the cell and the proteomic technology characterizes all protein in biological system including the complex features. This method increased the sensitivity and specificity by 100 and 95% respectively with a 94% positive predictive valve for ovarian tumours (Angela

It has been advocated that routine pelvic examination should be part of the screening process for ovarian cancers but non-randomized control trial has assessed the role of the bimanual pelvic examination for ovarian cancer screening. In the PLCO cancer trials no case of ovarian cancer was ovarian cancer was identified solely by bimanual examination (USPTF 2012) The American cancer society had advocated pelvic examination for asymptomatic women as one of the methods of screening for ovarian cancer in combination with other screening methods

The measurement of the volume of the ovaries has being used in screening of ovarian cancer. Transvaginal ultrasound scan can detect changes in the ovarian size and morphology. The

pausal women (Parlik EJ et al). Adding the parameters of cyst wall, characteristics and septation increases the sensitivity to 86% and a specificity of 99% for differentiating benign from malignant lesions(Depriest et al). It is however not recommended for population screening because of its low predictive value and lack of specificity. The combination of colour flow Doppler with transvaginal scan may assist in distinguishing malignant from benign lesions by measurement of the vascular resistance pattern of blood vessels supplying the

A combination of ultrasound scan, CA125 and menopausal status can be used in calculating the risk of malignancy index for patients and may buttress the need for more vigilance. The

1 for each of the following presence of multilocular, bilateral,solid components ascities and

risk of malignancy index of greater than 200 connotes a higher risk of malignancy.

and 10cm3

for postmeno‐

like CA 125 and transvaginal ultrasound scan (ACS 2012).

RMI=M x C x U (RCOG guideline,2003) where

metastatic disease with a maximum score of 3

M: Score of 1=premenopausal, 3=postmenopausal

upper limit of ovarian size for premenopausal women was 20cm3

The presence of the following features at laparoscopy may be suggestive of an ovarian malignancy size of the ovaries, bilaterally, surface excrescence dense adhesions, ascites and peritoneal lesions noted on laparoscopy. A combination of laparoscopy with transvaginal can improve the specificity of these methods but has the risk of tumor spill. This method of screening is expensive in terms of equipment, training of manpower and the surgical risk associated with the procedure for it to be advocated as a screening tool globally.

## **7.12. Screening for endometrial cancer**

There is no known standard recommendation for screening of endometrial cancers and the ACOG consider the process not cost effective and not warranted (ACOG 1997).Despite that there is need for appropriate medical history of menstrual abnormalities and occurrence of postmenopausal bleeding should initiate the need for further evaluation of the pa‐ tient.The history of tamoxifen use in a patient on hormonal therapy for breast cancer should increase the suspicion of possible endometrial malignancy. Physical examination and subsequent finding of bulky uterus in a postmenopausal patient should arouse the need for additional evaluation. Routine screening using transvaginal or biopsy is not recommend‐ ed for low risk or average risk patients however in patients with hereditary nonpolyposis colon cancer it is advised that screening be done as a routine from the age of 35 years annually (Birke 1997, Smith 2011)

#### **7.13. Endometrial biopsy/PAP smear**

There are different methods of assessment of the endometrial cavity amongst these are fractional curettage of the endometrium where samples are obtained from the uterus in four quadrants and sample send for histology looking out for premalignant lesions of the uterus such as atypical endometrial hyperplasia which is a possible precursor to endometrial cancer

However fractional curettage has the disadvantage of the samples collected not representative of the endometrial tissues. Other methods of collection of samples include vacuum aspiration and hysterscopically directed biopsy of suspicious lesions can also be done

Conventional PAP smear as a screening method for endometrial cancer is not advised since 50% of patients with endometrial cancer will have normal results (Gu, 2001) but improved specificity can be achieved if liquid based cytology is used in detecting glandular lesions

#### **7.14. Ultrasound scan**

This assesses the endometrial thickness using transvaginal ultrasound scan can be helpful in screening of patients with endometrial pathology. An endometrial thickness of 5mm has a high sensitivity and specificity for detecting endometrial pathology and a higher negative predic‐ tive value of about 100%(Smith –Bindman et at 1998)
