How Is Ovarian Cancer Diagnosed?

Ovarian cancer occurs when abnormal cells in or around the ovaries grow uncontrollably, forming into a mass (tumor). Approximately 1.1% of people who have ovaries will receive an ovarian cancer diagnosis in their lifetime. 

There is no reliable screening test to check for ovarian cancer in people who do not have symptoms. If you have symptoms of ovarian cancer or a strong family history of breast or ovarian cancer, your healthcare provider will perform a pelvic exam to check for fluid and/or lumps around your ovaries. Your healthcare provider may refer you to a gynecologic oncologist (GYO)—a doctor who specializes in treating cancers that affect the female reproductive system. The GYO will order diagnostic tests and procedures to provide an accurate diagnosis. 

This article covers the most common tests and procedures used to diagnose ovarian cancer. 

Medical History

When you see your healthcare provider, they will ask about your personal and family medical history to learn about your risk factors for ovarian cancer. Be sure to let your healthcare provider know if you have family members with a history of ovarian or breast cancer since these cancers can be hereditary. If you have symptoms of ovarian cancer, your provider will ask when they started and how often they occur. 

Pelvic Exam 

Your doctor will perform a pelvic exam to check for signs of ovarian cancer, such as fluid in your abdomen and lumps on and around your ovaries. To perform the pelvic exam, your doctor will place one or two gloved fingers inside your vagina and place their other hand on your abdomen. This helps them feel the size, shape, and position of your ovaries and uterus. 

Detecting ovarian cancer through pelvic exams is rare in the early stages of the disease, since most tumors will be too small to feel.

Imaging 

Imaging tests send forms of energy (e.g., sound waves, radioactive particles) to take pictures of the inside of your body. These pictures help your doctor look for a mass (tumor) on or inside of your ovaries, fallopian tubes, or the membrane lining the abdominal organs and abdominal cavity (peritoneum). 

Transvaginal Ultrasound 

A transvaginal ultrasound uses sound waves to produce pictures of the pelvic organs and structures. To perform this test, a probe is inserted into the vagina to get a clear view of the ovaries and uterus. An ultrasound can be used to find a mass on or around the ovaries. 

If a mass is detected, an ultrasound can provide an estimated size of the mass and help determine if the mass is solid (tumor) or fluid-filled (cyst). An ultrasound can also help detect fluid in the pelvis, which is often seen in more advanced ovarian cancers. 

Computed tomography (CT) scan

Computed tomography (CT) scans use X-rays to create cross-sectional images of your abdomen and/or pelvis. It may be used to help diagnose ovarian cancer, but is more often used to help doctors see if the cancer has spread (metastasized) into the lymph nodes, liver, intestines, and other organs. 

CT scans may also be used to guide a needle biopsy. A CT-guided needle biopsy helps doctors move a biopsy needle into a suspected tumor, remove a tissue sample from the mass, and send it to the lab for testing to determine if it is malignant (cancerous) or benign (non-cancerous).

Magnetic Resonance Imaging (MRI) scan 

Magnetic resonance imaging (MRI) scans produce cross-section pictures of your body and are highly accurate for determining whether a mass is malignant or benign. Though an MRI is rarely the first imaging scan used for detecting ovarian cancer, it is often used to provide more detailed information about masses detected on other imaging tests. An MRI is also helpful for examining other areas of the body, such as the spinal cord and brain, to determine if the cancer has spread. 

Blood Tests

In addition to a pelvic exam and imaging tests, your doctor may order blood work to check on your overall health, measure how well your kidneys and liver are functioning, and check your blood cell numbers, including your red blood cells, white blood cells, and platelets.

CA-125 Blood Test

This blood test measures the amount of a protein called cancer antigen 125 (CA-125). CA-125 is a tumor marker that is found in high levels in about 50% of people with early-stage ovarian cancers, and more than 80% of people with advanced ovarian cancers. 

This blood test alone cannot be used to diagnose ovarian cancer, because other conditions can cause elevated CA-125 levels, including endometriosis, pelvic inflammatory disease, and uterine fibroids. The CA-125 test is often used to monitor the effectiveness of ovarian cancer treatments. If levels go down, it typically means treatment is working. This test is also used after treatment is completed to see if the cancer has returned. 

Other Tumor Marker Blood Tests 

If imaging tests reveal a mass on or around your ovaries, your doctor may order a blood test to look for other tumor markers that are released into the blood by cancer cells. Elevated tumor markers can help your doctor determine the specific type of ovarian cancer you have. Your doctor may look for elevated levels of the following:

• Alpha-fetoprotein (AFP): AFP is a protein made by the liver when its cells are growing. A high AFP level is a potential sign of cancer.
• Human chorionic gonadotropin (hCG): hCG is a hormone that is commonly associated with pregnancy. However, it can also help indicate certain kinds of cancer—particularly cancer in the reproductive organs.
• Inhibin: This marker commonly co-occurs with CA-125.
• Lactate dehydrogenase (LDH): High LDH levels are associated with the presence of cancer cells, but isn’t specific to a type of cancer.

Surgical Biopsy 

A biopsy is the only way to know for certain if a tumor is malignant or benign. With ovarian cancer, a biopsy is most often done when the tumor is removed during surgery. A tissue sample is taken from the tumor and sent to the lab, where it is examined under a microscope by a pathologist—a doctor who specializes in examining body tissues and fluids—to look for cancer cells.  

Paracentesis 

Some people with ovarian cancer have ascites—excessive fluid buildup inside the abdomen. If surgery is not an option, a sample of this abdominal fluid may be taken during a procedure called a paracentesis. In this procedure, a needle attached to a syringe is passed through the abdominal wall and into the fluid. A sample of fluid is collected in the syringe and sent to the lab to check for cancer cells. 

Laparoscopy 

If surgery is not an option, a tissue sample may be obtained during a laparoscopy. This is a minimally invasive procedure that involves doctors making a small incision in the abdomen and inserting a flexible tube with a light and camera (laparoscope). The camera allows doctors to view the inside of the abdomen and pelvis to look for suspected cancerous masses.

A second abdominal incision may be made so doctors can remove a tissue sample (biopsy) from the tumor or lymph nodes in the pelvis and/or abdomen. The tissue sample is sent to the lab, where it is analyzed to see if it contains cancer cells. 

Colonoscopy 

Though a colonoscopy is most often used to diagnose colorectal cancer, it may be used in suspected cases of ovarian cancer to determine if the cancer has spread. 

During a colonoscopy, the doctor will insert a thin, flexible tube called a colonoscope into the anus, rectum and large intestine. The colonoscope has a small camera on the end, which allows doctors to see inside the rectum and colon to look for lumps and masses. A tissue sample (biopsy) can be removed during a colonoscopy and sent to the lab for examination. 

Genetic Testing

If you’ve been diagnosed with ovarian cancer, your doctor may recommend genetic testing to determine if you inherited certain gene mutations linked to ovarian cancer. Up to 25% of ovarian cancers are thought to be hereditary. 

Genetic tests are typically done by taking a sample of blood, saliva, or cheek cells. The most well-known gene changes associated with ovarian cancer are the BRCA1 and BRCA2 mutations, but several other genes have also been linked to ovarian cancer. 

If genetic testing shows you have inherited mutations associated with ovarian cancer, this information can show how your tumor may respond to certain treatments and help guide your doctor in developing a personalized treatment plan. Your genetic testing results can also determine whether you are at risk of other types of cancers, and may help your family members understand their risk of ovarian cancer. 

Stages of Ovarian Cancer 

After ovarian cancer is diagnosed, your oncologist (a medical doctor who specializes in cancer) will determine the stage. The stage of ovarian cancer refers to how large the tumor is and whether it has spread. Staging helps doctors determine the best treatment options and general prognosis (chance of recovery). 

There are four stages of ovarian cancer, ranging from early to advanced: 

• Stage 1: Cancer is confined to the ovaries and/or fallopian tubes and has not spread to nearby lymph nodes. About 15% of ovarian cancers are diagnosed in stage 1. 
• Stage 2: Cancer is found in the ovaries and/or fallopian tubes and has spread into other pelvic organs, like the uterus. About 19% of ovarian cancers are diagnosed in stage 2. 
• Stage 3: Cancer has spread outside of the pelvis into other areas of the abdomen and/or abdominal lymph nodes. About 60% of ovarian cancer cases are diagnosed in stage 3. 
• Stage 4: Cancer has spread outside of the pelvis and abdomen to more distant parts of the body, such as the liver, spleen, or lungs. Cancer cells may be detected in the fluid around the lungs in stage 4. About 6% of ovarian cancers are diagnosed in stage 4. 

Screening for Related Conditions 

Symptoms of ovarian cancer, like abdominal pain, bloating, and frequent urination, are similar to symptoms caused by many other conditions. Your doctor will use imaging tests, blood work, and other procedures to rule out other conditions and provide an accurate diagnosis. Conditions that mimic symptoms of ovarian cancer include: 

• Colon cancer
• Ectopic pregnancy 
• Endometriosis 
• Irritable bowel syndrome (IBS)
• Ovarian cysts
• Urinary tract infections
• Uterine fibroids

People who have ovarian cancer are at an increased risk of breast cancer, particularly those who have hereditary ovarian cancer caused by BRCA1 or BRCA2 gene mutations. If you have ovarian cancer, talk to your healthcare provider about how to reduce your risk of developing breast cancer. You may have more frequent breast cancer screenings (mammogram), take medication, or have surgery to reduce your risk of developing breast cancer.   

A Quick Review

Ovarian cancer is diagnosed through the use of imaging tests—transvaginal ultrasounds, CT scans, and MRIs—the CA-125 blood test, and tissue biopsy. If you are diagnosed with ovarian cancer, your healthcare team will develop a personalized treatment plan for you based on the type and stage of ovarian tumor(s) you have.