title: Routine pelvic examination during front-line chemotherapy for ovarian cancer: should it play a role?
abstract: OBJECTIVE
  To determine if pelvic examination affected management in patients undergoing first-line chemotherapy for ovarian cancer and to determine a threshold of change in tumor size reliably detectable by pelvic examination.
  
  
  METHODS
  We reviewed 501 encounters among 47 women with ovarian cancer to see if pelvic examination prompted a management change. Clinicians then evaluated synthetic model "tumors" and were retested at intervals of 3-48 hours to determine change needed for reliable detection.
  
  
  RESULTS
  The median number of examinations was 3 during 8 cycles of chemotherapy. Fifteen examinations (10.5%) revealed palpable anomalies, attributable to known tumor in 10 instances. The most common events preceding management change were elevation in serum CA-125 (57%) or chemotherapy toxicity (20%). No changes were made based on pelvic examination alone. When assessing "tumor" volume in a model, estimates ranged from 33-309% of actual volume. Determination of volume change following a delay was poor. No reliable threshold of detection of volume change was established.
  
  
  CONCLUSIONS
  Pelvic examination findings rarely dictated management changes in this study. Further, our results call into question the potential of routine pelvic examination to add significantly to clinical management during initial treatment given the wide range of error in "tumor" size estimates.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, USA. argenta@umn.edu
authors.forename: Peter A
authors.initials: PA
authors.lastname: Argenta
authors.forename: Rebekah R
authors.initials: RR
authors.lastname: Ormsby
authors.forename: Levi S
authors.initials: LS
authors.lastname: Downs
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Judson
authors.forename: Rahel
authors.initials: R
authors.lastname: Ghebre
authors.forename: Linda F
authors.initials: LF
authors.lastname: Carson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D014408:Biomarkers, Tumor / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology*; D010388:Pelvis / Q000473:pathology*; D010808:Physical Examination
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen