Preoperative evaluation of patients with suspected ovarian cancer.

A diagnosis of ovarian cancer should be suspected when a postmenopausal woman presents with a pelvic mass. The presence of ascites, which can be detected clinically or by ultrasound, increases the accuracy of the diagnosis. CA 125, although nonspecific in the premenopausal patient population, is very sensitive in postmenopausal patients when used in combination with clinical impression and an abnormal ultrasound. CAT scan is more sensitive than ultrasound, but may not alter surgical management. Preoperative preparation of the bowels should consist of a polyethylene glycol lavage in combination with oral and systemic antibiotics and is indicated for any woman with a mass adherent to the cul de sac. Preoperative total parenteral nutrition should be reserved for severely malnourished patients as determined by objective criteria. Early surgical intervention is a key component for the treatment of these patients, and extensive diagnostic testing should be used temperately in order to ensure expeditious treatment of these patients. In the future, the most significant impact on the survival of patients with ovarian cancer will be in the development of improved methods of screening and early detection. It is hopeful that clinical trials currently being conducted will bring us closer to that goal.