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Gynecological Ultrasound Ovary Normal Vs Serous Cystadenocarcinoma | Ovarian Cancer USG Findings

*Timestamps:
0:00 - Ultrasound Findings
8:26 - Lab Findings
9:47 - Signs & Symptoms

Cystic mass, with solid components and papillary projections.
Thick, irregular papillary projections
Mixed solid and cystic components
Large size, often 5–10 cm or greater
Frequently bilateral (especially high-grade serous carcinoma)
Marked internal vascularity
Flow within solid components, Papillary projections, Thick septations.
Papillary Projection: Surrounded by cystic fluid on at least 3 sides. Has a convex contour
Ascites: Common finding. Free fluid in, Pouch of Douglas, Paracolic gutters, or Upper abdomen. Often moderate to massive. May contain internal echoes (malignant ascites).
Peritoneal Metastases: Peritoneal thickening. Nodular peritoneal implants. Omental caking (appears as echogenic mass in anterior abdomen).
Lymph Node Involvement: Enlarged pelvic or para-aortic lymph nodes. Nodes may appear rounded, hypoechoic, with loss of fatty hilum.

Lab Tests:

CA-125
Most commonly elevated marker
Elevated in ~80–90% of advanced high-grade serous carcinomas
Less sensitive in early-stage disease

HE4 (Human Epididymis Protein 4)
More specific than CA-125
Often elevated in serous and endometrioid carcinomas
Less affected by benign gynecologic conditions
Used with CA-125 in ROMA score

ROMA Score:
Combines CA-125 + HE4 + menopausal status
Predicts risk of epithelial ovarian cancer
Not diagnostic, but helpful for risk stratification

Signs & Symptoms
Bloating / abdominal distension
Loss of appetite / early satiety
Obvious mass (pelvic/abdominal)
Ascites
Abdominal/pelvic pain
Systemic symptoms (fatigue, weight loss)