Confirming diagnosis Visualization of the ovary through ultrasound, computed tomography scan, laparoscopy, or surgery (often for another condition) confirms ovarian cysts.
Extremely elevated hCG titers strongly suggest theca-lutein cysts. Pregnancy, including molar pregnancy, must be ruled out.
In polycystic ovarian disease, physical examination demonstrates bilaterally enlarged polycystic ovaries. Tests reveal slight elevation of urinary 17-ketosteroids and anovulation (shown by basal body temperature graphs and endometrial biopsy). Direct visualization must rule out paraovarian cysts of the broad ligament, salpingitis, endometriosis, and neoplastic cysts.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Uterine cancer:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Unfortunately, a Papanicolaou test, so useful for detecting cervical cancer, doesn't dependably predict early-stage uterine cancer. Diagnosis of uterine cancer requires endometrial, cervical, and endocervical biopsies. (See Staging uterine cancer.) Negative biopsies call for a fractional dilatation and curettage to determine the diagnosis. Positive diagnosis requires the following tests for baseline data and staging:
❑multiple cervical biopsies and endocervical curettage to pinpoint cervical involvement
❑ Schiller's test, staining the cervix and vagina with an iodine solution that turns healthy tissues brown; cancerous tissues resist the stain
❑ complete physical examination
❑ chest X-ray or computed tomography scan
❑ excretory urography and, possibly, cystoscopy
❑ complete blood studies
❑electrocardiogram
❑ proctoscopy or barium enema studies, if bladder and rectal involvement are suspected.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Ovarian cancer:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Diagnosis of ovarian cancer requires clinical evaluation, complete patient history, surgical exploration, and histologic studies. Preoperative evaluation includes a complete physical examination, including pelvic examination with Papanicolaou smear (positive in only a small number of women with ovarian cancer) and the following special tests:
❑abdominal ultrasonography, computed tomography scan, or X-ray (may delineate tumor size)
❑ complete blood count, blood chemistries, and electrocardiogram
❑ excretory urography for information on renal function and possible urinary tract anomalies or obstruction
❑ chest X-ray for distant metastasis and pleural effusions
❑ barium enema (especially in patients with GI symptoms) to reveal obstruction and size of tumor
❑ lymphangiography to show lymph node involvement
❑ mammography to rule out primary breast cancer
❑ liver function studies or a liver scan in patients with ascites
❑ ascites fluid aspiration for identification of typical cells by cytology
❑ laboratory tumor marker studies, such as Ca-125, carcinoembryonic antigen, and human chorionic gonadotropin.
Despite extensive testing, accurate diagnosis and staging are impossible without exploratory laparotomy, including lymph node evaluation and tumor resection. (See Staging ovarian cancer.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
❑Spinal and lumbosacral magnetic resonance imaging confirm spinal tumor.
❑ X-rays show distortions of the intervertebral foramina; changes in the vertebrae or collapsed areas in the vertebral body; and localized enlargement of the spinal canal, indicating an adjacent block.
❑ Myelography identifies the level of the lesion by outlining it if the tumor is causing partial obstruction; it shows anatomic relationship to the cord and the dura. If obstruction is complete, the injected dye can't flow past the tumor. (This study is dangerous if cord compression is nearly complete because withdrawal or escape of cerebrospinal fluid (CSF) will allow the tumor to exert greater pressure against the cord.)
❑ Radioisotope bone scan demonstrates metastatic invasion of the vertebrae by showing a characteristic increase in osteoblastic activity.
❑ Computed tomography scan shows cord compression and tumor location.
❑ Frozen section biopsy at surgery identifies the tissue type.
❑ Lumbar puncture may be normal, abnormal, or nonspecific. It may show clear yellow CSF as a result of increased protein levels if the flow is completely blocked. If the flow is partially blocked, protein levels rise, but the fluid is only slightly yellow in proportion to the CSF protein level. Cytology of the CSF may show malignant cells of metastatic carcinoma.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Ovarian cysts:
Diagnosis
(Handbook of Diseases)
Generally, characteristic features suggest ovarian cysts. Visualization of the ovaries through ultrasound, laparoscopy, computed tomography scan, or surgery (commonly for another condition) confirms their presence. However, histologic examination is the only definitive method for an exact diagnosis.
Extremely elevated HCG titers strongly suggest theca-lutein cysts.
With polycystic ovarian disease, physical examination demonstrates bilaterally enlarged polycystic ovaries. Tests reveal slightly elevated urinary 17-ketosteroid levels and anovulation (shown by basal body temperature graphs and endometrial biopsy). Direct visualization must rule out paraovarian cysts of the broad ligament, salpingitis, endometriosis, and neoplastic cysts.
UNDER STUDY: CA-125 is an ovarian cancer marker that can help identify cancerous cysts in women. Hormone levels (luteinizing hormone, follicle-stimulating hormone, estradiol, testosterone) may be used to check for associated hormonal conditions.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Uterine cancer:
Diagnosis
(Handbook of Diseases)
Unfortunately, a Pap smear, so useful for detecting cervical cancer, doesn’t dependably predict early-stage uterine cancer. Diagnosis of uterine cancer requires endometrial biopsy and the following tests for baseline data and staging:
❑ complete physical examination
❑ chest X-ray or computed tomography scan
❑ complete blood count
❑ proctoscopy or barium enema studies, if bladder and rectal involvement are suspected.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Ovarian cancer:
Diagnosis
(Handbook of Diseases)
With ovarian cancer, diagnosis requires clinical evaluation, a complete patient history, surgical exploration, and histologic studies. Preoperative evaluation includes a complete physical examination, including pelvic examination with Papanicolaou smear (not clinically useful for ovarian cancer but helpful in diagnosing cervical dysplasia, cervical cancer, and some endometrial cancers) and the following special tests:
❑ abdominal ultrasonography, computed tomography scan, or magnetic resonance imaging (may delineate tumor size)
❑ complete blood count and blood chemistries
❑ chest X-ray for distant metastasis and pleural effusions
❑ barium enema (especially in patients with GI symptoms) to reveal obstruction and size of tumor
❑ mammography to rule out primary breast cancer
❑ liver function studies or a liver scan in patients with ascites
❑ laboratory tumor marker studies, such as CA-125, carcinoembryonic antigen, and human chorionic gonadotropin (the last two are mainly for suspected germ cell tumors).
Despite extensive testing, accurate diagnosis and staging are impossible without exploratory laparotomy, including lymph node evaluation and tumor resection.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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