American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with advanced ovarian cancer, how can diagnosis be made?

1. Biopsy of ovarian tissue only

2. Cytologic evaluation of ascites or pleural fluid

3. Physical examination alone

4. Laboratory tests on blood

The correct answer is: Cytologic evaluation of ascites or pleural fluid

In patients with advanced ovarian cancer, diagnosis can be effectively made through cytologic evaluation of ascitic or pleural fluid. This method is crucial because, in advanced cases, ovarian cancer often presents with peritoneal or pleural effusions. Analyzing the fluid can reveal malignant cells, which is indicative of cancer spread. Cytologic evaluation provides valuable information about the presence of cancerous cells and can help determine the extent of the disease. A biopsy of ovarian tissue alone may not be sufficient, especially in cases where the cancer has spread extensively; it might miss small foci of malignant cells in effusions. Relying solely on physical examination lacks the necessary specificity and sensitivity required to confirm a diagnosis of ovarian cancer, especially in its advanced stages. Laboratory tests on blood can provide ancillary information, such as measuring tumor markers like CA-125, but they do not provide definitive evidence of cancer diagnosis without the corroborating cytologic findings. Therefore, cytologic evaluation of ascites or pleural fluid stands out as the most effective diagnostic approach in this context.