Medical Evaluation and Diagnosis
Both PTC and FTC are usually diagnosed when a woman sees her doctor complaining of abdominal swelling and bloating. As described above, the symptoms of either cancer are more commonly gastrointestinal than gynecologic in nature. These symptoms are related to the accumulation of fluid, also known as ascites, that commonly occurs with either cancer. Gastrointestinal symptoms also occur because seedlings of tumor often line the peritoneal surface (the outer lining) of the intestines, a process called carcinomatosis. The omentum, an apron of fatty tissue that hangs down from the colon and stomach, often contains bulky tumor, described as omental caking. Although omental cakes can be detected on a physical exam, they frequently are subtle and difficult to detect. When a woman is found to have fluid in the abdomen (ascites), the usual first step toward a diagnosis is a CT scan. This is a special type of x-ray test that allows doctors to assess the entire abdomen and pelvis. Omental caking and ascites, as well as other tumor growths, are commonly seen, and point toward the diagnosis of PPC, FTC or ovarian cancer. Other cancers can cause these findings, thus, further tests are needed and are usually focused around ruling out other more common cancers, such as colon and breast cancer.
Frequently, the evaluation of ascites begins with a procedure known as a paracentesis, whereby fluid is removed from the abdomen using a needle. The fluid is examined under the microscope, looking for the presence of cancerous cells. Unfortunately, this procedure is not without risks as the process of performing a paracentesis can actually “seed” the abdominal wall with cancer cells. Therefore, it is important to seek the advice of a gynecologic oncologist when considering this procedure as it may not be necessary given that most patients with these findings will undergo surgery regardless of the results. However, it may be helpful in the patient who is either not a surgical candidate, or in one suspected of having ascites for reasons other than cancer, such as liver or heart disease. Sometimes fluid is even drawn off because of patient discomfort until surgery or chemotherapy can be scheduled.
There are several blood tests that are frequently performed when either PPC or FTC is suspected. The most common of which is the CA 125 blood test. CA 125 is a chemical that is made by tumor cells and is usually elevated in patients with PPC and FTC. Unfortunately, it can also be elevated in a variety of benign conditions, as well as other cancers, and thus an elevated CA 125 blood test does not mean the patient has a cancer. More recently a newer blood test, HE4, can also be used as it is less likely elevated than CA 125 in benign conditions. You can read more about CA 125 with our brochure, CA 125 Levels: Your Guide.
The actual diagnosis of PPC or FTC is often not completely certain until a woman undergoes surgery. This is because the clinical presentation of either disease is so similar to that of epithelial ovarian cancer. PPC, FTC and ovarian cancer appear identical under the microscope. It is the pattern of tumor distribution and organ involvement in the abdominal cavity that indicates the origin of the primary cancer. Patients with FTC usually have gross involvement of the fallopian tubes with lesser involvement of the ovaries. Patients with PPC are usually found to have normal ovaries, or only superficial involvement of the ovaries, at the time of pre-surgical imaging tests or at time of surgery. However, the diagnosis can occasionally remain uncertain even following surgery.