Common Scans

The most widely used scans in gynecologic cancers are the ultrasound, which is great for pelvic evaluation and the CT scan, which is pretty good for other things like the abdomen, organs at risk for spread of gynecologic cancers (liver, lungs) and your lymph nodes.  We will leave the PET scan alone for the moment, which is a physiologic scan that is more advanced but not always "better".  It is just another tool that helps from the perspective of a different way of scanning: physiologic uptake of radioactive sugar rather than the "anatomic" ultrasound and CT scans, which look at normal vs. abnormal shapes and anatomy.  The MRI is sometimes used in gynecologic cancers, but that will be covered elsewhere.  It is not as commonly used as ultrasound and CT or "Cat" scans, but can be helpful in specific circumstances.  

Pelvic Ultrasound

First regarding ovaries. Ultrasound, which uses sound waves, is often the scan that is first used to evaluate or find an ovarian mass or tumor. Remember, "tumors" can be benign or malignant, so the term "tumor" only means an enlargement. What it is can't be proven until it is removed, if that is required. Also, the malignancy risk for epithelial (the most common ovarian cancer) goes up with age, except for the uncommon germ cell or sex-cord stromal tumors that can occur in the second, third and fourth decades of life.

The first language to look for is whether or not the ovarian mass or enlargement is a "simple cyst" or "complex". Simple cysts are rarely malignant, especially if they are small. Next, if it is described as being complex, is there language which further describes what the complexity is? If it is complex because it has a "septum", which is only a separation between several parts of a cyst, it is less likely to be malignant or cancerous. If the complexity is noted to contain nodules or "excresences" or multiple solid parts, then it is more likely to be something to be concerned about.

Next, what is the size of the mass? Although there are no clear cut-off points, simple cysts that are less than 10 centimeters (size of an orange) are unlikely to be malignant.

Finally, is there any mention of "free fluid" in the pelvis? This may mean that there is "ascites" which is part of the ovarian cancer growth process. It does not prove that you have cancer,and a small amount can be a normal finding, but a lot of free fluid or "ascites" is more worrisome.

For uterine abnormalities, the ultrasound can be helpful to see if there are polyps or a thickening of the inside of the uterus.  Sometimes that can mean overgrowth of your "endometrium" or the internal lining of the uterus.  This can be benign or malignant. Malignancy of the endometrium is mostly found in the post-menopausal years, but can occur in younger women over 35.  Abnormal growths or tumors of the muscle part of the uterus, myometrium, can also occur and are usually benign (fibroids or leiomyomas) but can be sarcomas.  These are rather rare and looks a lot "uglier" on the scan to the radiologist. 

Cervical abnormalities can be seen on ultrasound, and may be helpful.  However, in most cases, since the cervix is the lowest part of the uterus and can be seen and felt in the vagina on examination, physical inspection rather than scanning is "better".  

CT or CAT Scan