Laboratory Workup for a Potential Pelvic Mass

Initial Laboratory Evaluation

The National Comprehensive Cancer Network recommends serum CA-125 measurement as part of the initial evaluation of a pelvic mass to help differentiate between benign and malignant processes 3, 4
A complete blood count (CBC) should be performed to assess for anemia or other hematologic abnormalities that may be associated with malignancy in patients with a pelvic mass 5, 6
The National Comprehensive Cancer Network suggests that a comprehensive metabolic panel including liver function tests (LFTs) and renal function tests should be obtained to evaluate organ function and establish baseline values in patients with a pelvic mass 5, 6
Lactate dehydrogenase (LDH) measurement is recommended as it can be elevated in certain types of ovarian malignancies, particularly germ cell tumors, according to the Annals of Oncology 1, 2

For women younger than 35 years with a pelvic mass, the National Comprehensive Cancer Network recommends measuring alpha-fetoprotein (AFP) levels to assess for germ cell tumors and to rule out pregnancy 7, 8
Human chorionic gonadotropin (hCG) should be measured in young patients to rule out pregnancy and evaluate for certain germ cell tumors, as suggested by the Annals of Oncology 1, 2
Inhibin levels should be considered, particularly if a granulosa cell tumor is suspected, as it is a useful marker for this disease, according to the Annals of Oncology 1, 2

For suspected mucinous histology, the National Comprehensive Cancer Network recommends measuring carcinoembryonic antigen (CEA) and performing a gastrointestinal tract evaluation to determine whether the mass represents a primary ovarian tumor or metastasis from a gastrointestinal primary 9, 3
In cases of suspected gonadoblastomas, a preoperative karyotype should be obtained, especially in pre-menarche girls, due to the propensity of these tumors to arise in dysgenetic gonads, as suggested by the Annals of Oncology 1, 2

For sex cord-stromal tumors, which may produce hormones, additional endocrine evaluation may be necessary, according to the National Comprehensive Cancer Network 7
In patients with suspected non-epithelial ovarian cancers, a more extensive tumor marker panel (CA-125, inhibin, beta-hCG, AFP, and CEA) should be considered, as recommended by the National Comprehensive Cancer Network 7, 8

Relying solely on CA-125 for diagnosis, as it can be elevated in many benign conditions and may not be elevated in early-stage ovarian cancer, according to the National Comprehensive Cancer Network 11
Failing to consider age-appropriate tumor markers, which may lead to missed diagnoses, particularly in younger patients, as suggested by the National Comprehensive Cancer Network 7, 8
Not performing a gastrointestinal evaluation in patients with mucinous histology, which could result in misdiagnosis of metastatic disease as primary ovarian cancer, according to the National Comprehensive Cancer Network 9, 3