Question

A 72-year-old G3P2 postmenopausal woman is referred by her internist after work-up for abdominal bloating revealed a large pelvic mass on transvaginal ultrasound and an elevated CA-125. The patient had a normal colonoscopy and mammography two months ago. The patient's greatest complaint is early satiety and upper abdominal discomfort. Her physical exam is notable for moderate abdominal distension and a significant fluid wave. Which of the following tests would be most helpful in assessing the extent of disease?

A. Barium enema
B. PET scan
C. CT scan of abdomen and pelvis
D. Chest X-ray
E. Intravenous pyelogram

Answer 1

A CT scan of the abdomen and pelvis is the most informative and immediate test to assess the extent of disease in the described patient, given her symptoms and ultrasound findings.

Step-by-step explanation:

To assess the extent of disease in a 72-year-old postmenopausal woman with a large pelvic mass, an elevated CA-125, and symptoms such as early satiety and abdominal bloating, the most helpful test would be a CT scan of the abdomen and pelvis. This scan provides detailed X-ray images of the abdominal organs and can help in staging the disease by showing the size of the mass, involvement of surrounding structures, and the presence of any metastasis or ascites. Other tests like a PET scan could also be informative but are generally used after a CT scan has delineated the extent of the disease. While laparoscopy is a direct method of visual inspection and can provide definitive diagnosis especially for conditions like endometriosis, in the context of a suspected malignancy with the given presentation, a non-invasive staging tool like a CT scan is the initial investigation of choice.