What Does Ovarian Cancer Look Like on Ultrasound?

Ovarian cancer is a serious and potentially life-threatening condition that primarily affects the ovaries, which are the reproductive organs in women responsible for producing eggs and hormones. Ultrasonography, particularly transvaginal ultrasound, is a commonly used imaging technique to detect and evaluate ovarian abnormalities, including cancer. This non-invasive procedure allows healthcare professionals to visualize the ovaries and surrounding structures, helping to diagnose ovarian cancer and determine the extent of the disease.

Basics of Ovarian Cancer

Ovarian cancer can arise from various cell types within the ovary, and it is often classified into epithelial, germ cell, and stromal tumors. Epithelial ovarian cancer is the most common type, accounting for the majority of cases. It arises from the cells that cover the outer surface of the ovary. Ovarian cancer is notorious for being challenging to detect in its early stages because symptoms are often vague and nonspecific.

Transvaginal Ultrasound: A Diagnostic Tool

Transvaginal ultrasound is a valuable imaging modality for assessing the female reproductive organs, including the ovaries. This technique involves inserting a probe into the vagina, allowing for close proximity to the pelvic organs and providing high-resolution images. During the ultrasound examination, several features are assessed to determine if there are any abnormalities suggestive of ovarian cancer.

Sonographic Features of Ovarian Cancer

• Ovarian Masses: Ovarian cancer often presents as an abnormal mass within the ovary. On ultrasound, these masses may appear as solid, cystic, or a combination of both (complex). The characteristics of the mass, such as size, shape, and internal structure, are crucial in determining the likelihood of malignancy.
• Solid Components: Malignant ovarian tumors frequently contain solid components, which may appear as irregular or nodular areas within the mass. Solid components are a concerning feature, as they suggest a higher likelihood of malignancy compared to purely cystic masses.
• Irregular Borders: Ovarian cancers often exhibit irregular or poorly defined borders on ultrasound. Unlike benign cysts, which typically have smooth, well-defined edges, malignant masses may infiltrate surrounding tissues, leading to irregular borders.
• Ascites: Ascites, the accumulation of fluid in the abdominal cavity, is a common finding in advanced ovarian cancer. Ultrasound can detect ascites as a dark, fluid-filled space around the uterus and ovaries. The presence of ascites is indicative of advanced disease and may influence the staging of ovarian cancer.
• Blood Flow: Doppler ultrasound, a specialized technique that assesses blood flow, can be used to evaluate the vascularity of ovarian masses. Malignant tumors often exhibit increased blood flow compared to benign lesions. The presence of abnormal blood vessels within the mass is known as neovascularization and can be a concerning sign.
• Multilocularity: Some ovarian cancers may present with multilocular cystic structures, meaning the mass has multiple cystic spaces. This is in contrast to simple cysts, which have a single fluid-filled space. The presence of multilocularity may raise suspicion for malignancy.

Staging and Grading Ovarian Cancer

Once ovarian cancer is diagnosed through ultrasound and other imaging modalities, healthcare providers use staging and grading systems to determine the extent of the disease and its aggressiveness.

• Staging: Ovarian cancer staging is based on the extent of tumor spread and involvement of adjacent structures. Stages range from I (confined to the ovaries) to IV (spread to distant organs). Ultrasound plays a crucial role in assessing the involvement of nearby structures, lymph nodes, and the presence of ascites.
• Grading: Grading evaluates the degree of differentiation of cancer cells. Higher-grade tumors often indicate a more aggressive disease. While ultrasound is not the primary tool for grading ovarian cancer, it provides essential information for determining the tumor’s size, characteristics, and involvement of nearby structures.

Challenges and Limitations

Despite its utility, transvaginal ultrasound has limitations in the diagnosis of ovarian cancer. Benign conditions, such as ovarian cysts, endometriomas, and certain types of tumors, can mimic the appearance of malignant masses on ultrasound. Additionally, small or early-stage ovarian cancers may not be easily detected, emphasizing the importance of considering clinical symptoms, risk factors, and other diagnostic tests in conjunction with ultrasound findings.

Conclusion

In conclusion, transvaginal ultrasound is a valuable tool in the diagnosis and evaluation of ovarian cancer. The sonographic features, such as the nature of the mass, presence of solid components, irregular borders, ascites, blood flow, and multilocularity, play a crucial role in differentiating between benign and malignant ovarian lesions. The use of ultrasound in conjunction with clinical history, physical examination, and other imaging modalities contributes to a comprehensive approach in the diagnosis and management of ovarian cancer.

While ultrasound is instrumental in identifying ovarian abnormalities, a multidisciplinary approach involving gynecologists, radiologists, and oncologists is essential for accurate diagnosis, staging, and treatment planning. Advances in imaging technology, including the integration of Doppler ultrasound and three-dimensional imaging, continue to enhance our ability to detect and characterize ovarian cancer, ultimately improving patient outcomes through earlier diagnosis and targeted treatment strategies.