Role of Upper and Lower GIT Endoscopy in Patients with Suspected Bilateral Adnexal Masses

Background: Ovarian malignancy is considered the third most common gynecologic cancer. Secondary ovarian tumors comprise 10–25% of all ovarian malignancies, Most common sites of primary tumor identified so far are from the stomach, colon, rectum, breast, endometrium, and appendix. Endoscopy is recommended especially in cases with signs suggestive of GI tract involvement, as bilateral adnexal masses. Still 20%-25% of primary HGSC are presented as bilateral tumors and hence bilateral ovarian tumors is not always metastatic tumors. This practice may has economic burden specially in low resources countries. So, this practice need to be investigated about its value and need to be justified.

Methods: This retrospective clinical study evaluated the role and efficacy of GIT endoscopy in cases with bilateral suspected adnexal masses to diagnose secondary ovarian cancers with GIT primaries and to correlate between different modalities of investigations as tumor markers and imaging techniques.

Results: A total of 33 patients with suspected with bilateral suspected adnexal masses confirmed by imaging who underwent upper and lower endoscopy were included, 21 patients finally diagnosed as primary ovarian tumors, and 12 patients with secondary ovarian metastasis. Upper endoscopy findings were free of abnormalities in the majority of both groups, but abnormalities were significantly more frequent in the metastatic tumor group. Similarly, findings of colonoscopy also varied between the groups. However, this difference did not reach statistical significance (P = 0.054).

Conclusions: This study supports a risk-adapted approach to gastrointestinal evaluation in patients with suspected ovarian cancer. By relying on imaging and tumor markers to guide the use of endoscopy, clinicians can minimize unnecessary procedures, reduce healthcare costs, and focus resources on patients most likely to benefit.