Screening for Ovarian Cancer: The Possible Improvement by 3D Ultrasound and 3D Power Doppler

Abstract

In developed countries more women die annually from ovarian cancer than from all other gynecologic malignancies combined. The fact that the ovaries are deep within the pelvic cavity and difficult to palpate is an obstacle to early diagnosis, especially in peri-post menopausal women, the group with the highest incidence of the disease. Seventy percent of patients are not diagnosed with the disease until the cancer has metastasized beyond the ovaries and is at stage 3 or 4. Patients with stage 3 or 4 have a 5-year survival rate of only 20-30%. Given the burden of suffering associated with ovarian cancer and the clear survival gradient related to the stage of disease at diagnosis, there is great need for development of effective screening methods for early detection of epithelial ovarian cancer. Better understanding of ovarian cancer etiology and increasing knowledge of tumor biology have both contributed to identify efficient Serum Tumor Markers, to screen high-risk populations. Technical advances in the field of ultrasound made transvaginal sonography (TVS) become the most important diagnostic tool, and multimodal (Serum markers plus TVS) screening appears to be a diagnostic break-through in fighting ovarian cancer. Five case reports illustrate that new ultrasound technologies such as 3D volume acquisition and 3D power Doppler imaging promise more reliable identification of an abnormal ovarian tumor vascularity and tumor-typical vascular architecture, thus facilitating early stage 1 -detection of the disease.