Comparto lo expresado por la Dra. Verdinelli y creo que todos tenemos claro este concepto. El inconveniente que nos vemos a diario, al menos en Rosario, pero creo que es comun para todos que la gente de Andar no tienen muy claro este concepto y vienen los reclamos para que las autoricemos. Hago referencia a esa obra social ya que son los que en general reclaman cuando no se autoriza.

AQUI ESTA CLARO QUE NO DEBE HACERSE

SALUDOS

Practice Essentials

Ovarian cancer is the most common cause of cancer death from gynecologic tumors in the United States. Malignant ovarian lesions include primary lesions arising from normal structures within the ovary and secondary lesions from cancers arising elsewhere in the body. Primary lesions include epithelial ovarian carcinoma (70% of all ovarian malignancies). Current research suggests that the majority of these originate from the fallopian tubes.  

Stromal tumors of the ovary include germ-cell tumors, sex-cord stromal tumors, and other more rare types. Metastases to the ovaries are relatively frequent; common sources are tumors in the endometrium, breast, colon, stomach, and cervix. See the image below.

An enlarged ovary with a papillary serous carcinoma on the surface.

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Signs and symptoms

Early ovarian cancer causes minimal, nonspecific, or no symptoms. The patient may feel an abdominal mass. Most cases are diagnosed in an advanced stage.

Epithelial ovarian cancer presents with a wide variety of vague and nonspecific symptoms, including the following:

• Bloating; abdominal distention or discomfort

• Pressure effects on the bladder and rectum

• Constipation

• Vaginal bleeding

• Indigestion and acid reflux

• Shortness of breath

• Tiredness

• Weight loss

• Early satiety

Symptoms independently associated with the presence of ovarian cancer include pelvic and abdominal pain, increased abdominal size and bloating, and difficulty eating or feeling full. [1] Symptoms associated with later-stage disease include gastrointestinal symptoms such as nausea and vomiting, constipation, and diarrhea. [2] Presentation with swelling of a leg due to venous thrombosis is not uncommon. Paraneoplastic syndromes due to tumor-mediated factors lead to various presentations.

See Presentation for more detail.

Diagnosis

Physical findings are uncommon in patients with early disease. Patients with more advanced disease may present with ovarian or pelvic mass, ascites, pleural effusion, or abdominal mass or bowel obstruction.

The presence of advanced ovarian cancer is often suspected on clinical grounds, but it can be confirmed only pathologically by removal of the ovaries or, when the disease is advanced, by sampling tissue or ascitic fluid.

Screening

The US Preventive Services Task Force (USPSTF) recommends against screening (with serum CA-125 level or transvaginal ultrasonography) for ovarian cancer in the general population. [3] The US Food & Drug Administration (FDA) recommends against the use of tests marketed for ovarian cancer screening. [4] The National Cancer Institute (NCI) cites evidence of lack of mortality benefit with screening, and potential harms relating to false-positive test results. [5]

Laboratory testing

No tumor marker (eg, CA-125, beta-human chorionic gonadotropin, alpha-fetoprotein, lactate dehydrogenase) is completely specific; therefore, use diagnostic immunohistochemistry testing in conjunction with morphologic and clinical findings. Also, obtain a urinalysis to exclude other possible causes of abdominal/pelvic pain, such as urinary tract infections or kidney stones.

Imaging studies

Routine imaging is not required in all patients in whom ovarian cancer is highly suggested.

Hola  todos! Asi como dicen Horacio y Cecilia,en todos lados tenemos el problema de los famosos "rastreos" que se dan por necesarios y beneficiosos solo porque "lo hacen todos" o porque se transforma en una costumbre que se lleva adelante sin pensar, o como decía mi mamá, "si poco te hace bien, mucho te hará mejor", así que sin cuestionarse sus prácticas, muchos profesionales siguen pidiendo prácticas obsoletas y a veces perjudiciales para el bienestar, la salud y la tranquilidad de los pacientes / afiliados. Habrá que insistir y blandir la espada de la evidencia y además compartirla para sumar adeptos!  Abrazo grande!