Tumor markers do not mean only substances that are released as a response to cancer. This means that the CA 125 tumor marker value alone does not mean a diagnosis of ovarian malignancy. (For more information, you can read the article – Markers for ovarian tumors) Other markers or signs that can direct the attention of the clinician in the direction of an oncological process are also the morphology of the ovaries during ultrasound examination, and also the characteristics of the ovarian vascular network. The specificity for detecting ovarian cancer after testing CA 125 level increases to 99.9% after ultrasound diagnosis of the pelvis and reproductive organs in postmenopausal women. Ultrasound examination aims to determine the earliest changes in ovarian architectonics; changes that are associated with carcinogenesis. Transvaginal ultrasound is the preferred method because of its better image resolution. NEWS_MORE_BOX In this study, both volume and morphology were assessed according to menopausal status. The usual volume of one ovary varies from 10 to 20 ml. Ovarian lesions suspicious for a certain type of disease are complex in morphology, solid and bilateral (affecting both ovaries). Also, persist when re-examined after 4-6 weeks. Increased ovarian volume, the presence of papillary projections from the lesion and a complex cystic wall with numerous lacunae, thickened septa and high echogenicity (density) of the fluid can be risk marks for a malignant process. These findings, which are associated with an extremely low risk of malignancy, are usually unilateral (affecting only one of the two ovaries), less than 10 mm in size, and fluid in nature. In the differentiation of a malignant process from a benign process, in addition to the levels of CA 125 and ultrasound examination, the vascular network of the ovaries and the suspicious lesion can be evaluated. This is done after the so-called Doppler examination. Neovascularization (formation of new vessels) is an obligatory process occurring during tumor growth. The new vessels of fast-growing neoplasms have fewer smooth muscle cells in their walls and thus create less resistance to blood flow. Color-flow Doppler examination uses prior changes in blood dynamics at the local level to differentiate a malignant from a benign process. It should be noted that not all ultrasound findings correspond to a malignant process. In more than half of the cases, benign neoplasms of the ovaries are diagnosed, which do not always require surgical intervention.