Case Presentation

A 28-year-old African American woman arrived at the emergency room experiencing abdominal pain in her lower left pelvis. She had no previous diagnosis of cancer, nor did any of her family.

Clinical Impression

While at the emergency room a CT scan and X-ray were ordered, revealing a mass on the patient’s left ovary. The patient was referred to her ObGyn, who performed a sonogram and determined surgical intervention would be appropriate. To help decide if a specialist referral was necessary, an OVA1 was ordered to help determine the likelihood of cancer. The OVA1 score came back as a 6.7, indicating an increased likelihood of cancer and resulting in the patient being referred to a gynecologic oncologist for her surgery.

Diagnosis

Patient was diagnosed with a Stage IA ovarian cancer, a squamous cell carcinoma arising from a mature teratoma.

Use of OVA1

The OVA1 test helped detect this malignancy in the earliest stage, which led to referral of the patient to the specialist and improved her chance of survival.

Case Presentation

A 72-year-old patient presented with an asymptomatic left adnexal mass reflected on routine examination.

Clinical Impression

The patient was found on routine examination to have an 8cm left adnexal mass which was a new finding from an examination performed one year previously.

The sonogram showed that the mass did have cystic components and septae. There was no fluid in the cul-de-sac and otherwise the findings were benign. The patient wanted to be operated on locally, because of an infirmed husband. The treating physician consulted with Dr. Barter, who suggested an OVA1 be ordered to help give a probability of malignancy. The test was ordered and the result came back at 4.0 which is below the postmenopausal cutoff of 4.4, indicating a lower probability of malignancy.

Diagnosis

The patient underwent a local laparoscopic bilateral salpingo-oophorectomy (BSO) performed by her treating physician without problems and pathology revealed a benign mucinous cystadenoma.

Use of OVA1

In this case, the use of OVA1 was very important because the score indicated a benign lesion. This allowed the patient to be operated on locally by a non-gynecologic oncologist. Had the score been elevated, the patient had agreed to travel to a gynecologic oncologist. In a postmenopausal patient with this type of mass, there is a high likelihood of malignancy. The use of OVA1 revealed benign findings and the patient did not need to be referred.

Case Presentation

A 36-year-old Caucasian woman presented with abdominal pain. She had no previous diagnosis of cancer, although her paternal grandmother had breast cancer.

Clinical Impression

A pelvic mass with septated and solid components measuring 17cm x 13cm x 12cm was discovered during physical exam and subsequent ultrasound. Dr. Drosman determined surgery would be the appropriate course of action and ordered an MRI and OVA1 to determine a likelihood of malignancy. The resulting OVA1 score was 9.1, which was above the premenopausal cutoff of 5.0 and indicated a higher probability of cancer. As a result, the patient was referred to a gynecologic oncologist for surgery.

Diagnosis

Upon surgery, metastatic disease was found to have spread throughout the pelvis spillage and preoperative rupture. The patient was diagnosed with Stage IV metastatic ovarian cancer.

Use of OVA1

The OVA1 test result showed the tumor had a high likelihood of malignancy for ovarian cancer based on the index score value, thus providing information previously unavailable for decision making. It was Dr. Drosman’s experience that masses of similar characteristics upon ultrasound were endometriosis; however, using OVA1 in conjunction with his clinical assessment identified a high likelihood of malignancy and led to her referral to the appropriate surgical setting.

Case Presentation

A 57-year-old female complained of postmenopausal bleeding at her annual visit. Her bimanual exam was limited by her narrowed vagina and the presence of ascites due to her known primary biliary cirrhosis, for which she was on the liver transplant list.

Clinical Impression

Pelvic ultrasound was performed to evaluate the thickness of her endometrial stripe. It showed a 5cm complex septated left adnexal mass. Ascites was noted. Her endometrium was mildly thickened at 8.7mm. In addition to her primary biliary cirrhosis, the patient had previously been treated with lumpectomy, chemotherapy, and radiation for breast cancer 11 years prior to this exam.

A CA-125 was drawn, returning a score of 70; however this elevation was expected due to her known ascites.

To help ascertain her risk for cancer given this confounding medical condition, an OVA1 was ordered. It was 6.4, which indicated a higher probability for cancer based on a 4.4 cutoff for postmenopausal women. Thus, the patient was referred to a gynecologic oncologist.

Diagnosis

The oncologist started with a laparoscopy due to lowered suspicion of ovarian cancer, but converted to a full ovarian cancer staging surgery upon receiving a cancer diagnosis on frozen section. The patient ended up having a Grade 2 serous adenocarcinoma of the ovary which was intact. Pelvic washings were negative for malignant cells. There was no evidence of metastatic spread and so this was considered a Stage IA Grade 2 disease. The options of expectant management versus adjuvant chemotherapy were offered to her. Her prognosis is guarded and she will have frequent follow-up exams.

Use of OVA1

The OVA1 test results indicated a high likelihood of ovarian cancer based on the predetermined cutoffs. Had the OVA1 score came back below the 4.4 cutoff, the patient likely would not have been referred to the gynecologic oncologist for her surgery. Yet, the elevated OVA1 score helped refer her to the most appropriate surgical setting where she received a complete ovarian cancer staging surgery.

Case Presentation

A Caucasian 39-year-old, premenopausal woman went to the emergency room after experiencing pain in her lower left abdomen for three months. She reported no family history of cancer.

Clinical Impression

While at the emergency room a CT scan was run, as well as a transvaginal ultrasound. A complex ovarian cyst was discovered measuring 4.2cm x 2.3cm. The patient was then referred to Dr. Cohen. Since it had been approximately three weeks since her trip to the ER, Dr. Cohen ordered a repeat ultrasound confirming the presence of the mass. Thinking this could be a dermoid, endometriosis or a hemorrhagic cyst, a CA-125 was ordered and it returned at 177, which is under the 200mL cutoff.

Upon receiving her prior records it was learned the patient had an oophorectomy on her right ovary at age 31 for a borderline serous tumor. Taking into account her previous history, and that she was still experiencing pain, Dr. Cohen determined surgery was appropriate and ordered an OVA1 test. The test score came back elevated at 6.0. Based upon the OVA1 score and the overall assessment, the patient was referred to a gynecologic oncologist for surgery. Without the availability of OVA1, Dr. Cohen would have performed an exploratory laparotomy.

Diagnosis

The gynecologic oncologist performed a left ovarian cystectomy which revealed another borderline serous tumor. The patient also wanted to preserve her fertility and therefore her ovary was left intact. The prognosis for her ability to have children is promising.

Use of OVA1

By incorporating OVA1 into the clinical impression the patient was correctly referred to the specialist for her surgery.