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- Ovarian Cancer
- Ovarian Cancer Diagnosis
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At MD Anderson, our experts use the most advanced and accurate equipment available for ovarian cancer diagnosis and determine with pinpoint accuracy if and where it has spread. They have extensive experience with all types of ovarian cancer, including rare ovarian cancers. The chances for successful ovarian cancer treatment are much higher if the cancer is caught early and diagnosed accurately.
Testing for ovarian cancer
If you have symptoms that may signal ovarian cancer, your doctor will examine you and ask you questions about your health and family medical history. One or more of the following tests for ovarian cancer may be used to find out if you have the disease and if it has spread. These tests also may be used to find out if treatment is working.
Pelvic exam
The doctor inserts one or two gloved fingers into the vagina and presses on the lower abdomen with the other hand. Usually the doctor puts a finger in the vagina and rectum at the same time to feel deeper in the pelvis. A pelvic exam helps find out if there is a mass on either side of the uterus. This may be a sign of ovarian cancer.
Blood test for ovarian cancer
The blood tests for ovarian cancers will depend on the exact type of ovarian cancer that is suspected or diagnosed. Among the common tests used for epithelial ovarian cancer is CA-125. This blood test measures the level in your body of CA-125, a protein that is made by ovarian cancer cells. CA-125 is known as a tumor marker because its levels usually are higher in women with ovarian cancer. Testing CA-125 levels is most reliable when it is used to find cancer that has come back after treatment. Doctors look at how the levels of CA-125 have changed over time.
Measuring CA-125 levels also can be used:
- To see if treatment is working
- To predict if a treatment might be effective for ovarian and some other types of cancer
The CA-125 test alone cannot find ovarian cancer. A high level of CA-125 does not always mean you have ovarian cancer. Other conditions may raise the level of CA-125. Low levels of CA-125 do not mean you are cancer-free. Some types of ovarian cancer produce only low levels of CA-125 or none at all.
There are many other types of blood tests that may be requested by the gynecologic oncologist based on the exact subtype of ovarian cancer.
Ovarian cancer biopsy
The only way to find out for certain if a growth is ovarian cancer is for the doctor to remove tissue from it and look at it under a microscope. This is called a biopsy. Tissue can be removed by:
- Surgery
- Laparoscopy
- Fine needle aspiration (FNA)
However, if a mass appears confined to the ovary, then surgery to remove it may be the most appropriate next step. The mass is biopsied after it is removed.
Ovarian cancer imaging
The following imaging exams may be used to diagnose ovarian cancer:
- CT or CAT (computed axial tomography) scans
- MRI (magnetic resonance imaging) scans
- PET (positron emission tomography) scans
- Chest X-rays
- Transvaginal ultrasound: A wand-shaped scanner is put into the vagina. It has a small ultrasound device on the end.
Genetic testing for ovarian cancer
If you are at high risk for ovarian cancer because of personal or family history, your doctor may ask you to have more tests, including some that give information about your genes. These tests may help you make important decisions about cancer prevention for yourself and your children. Blood tests can find out if you have a BRCA1 or BRCA2 gene, which can cause ovarian cancer as well as breast cancer. Others test for genes that play a part in Lynch syndrome, an inherited colon cancer syndrome. For many types of ovarian cancer, genetic counseling and testing is routinely recommended for all such patients.
There are benefits and risks with genetic testing, which you should discuss with your doctor.
How is ovarian cancer diagnosed?
Ovarian Cancer Staging
Staging is a way of determining how much disease is in the body and where it has spread. This information is important because it helps your doctor decide the best type of treatment for you and the outlook for your recovery (prognosis). Staging of ovarian cancer is done during surgery. It usually requires removing the uterus, ovaries and fallopian tubes, as well as the omentum (a layer of fatty tissue covering the stomach area) and lymph nodes close to the tumor.
Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.
Did You Know?
Ovarian Cancer Stages
(source: American Cancer Society)
Stage I ovarian cancer
The cancer is limited to the ovary or ovaries.
- Stage IA: Cancer is in one ovary.
- Stage IB: Cancer is in both ovaries but not on their outer surfaces.
- Stage IC: Cancer is in one or both ovaries. It is also on the surface of the ovary, in abdominal fluid or a fluid-filled capsule has burst.
Stage II ovarian cancer
The cancer is in one or both ovaries. It has also spread to other organs in the pelvis (such as the uterus, bladder, the sigmoid colon or the rectum).
- Stage IIA: The tumor has spread to the uterus, fallopian tubes or both.
- Stage IIB: The tumor has spread to the bladder, rectum or colon.
Stage III ovarian cancer
The cancer is in one or both ovaries. It has spread to nearby lymph nodes or other abdominal organs, not including the liver.
- Stage IIIA1, the cancer:
- Is in one or both ovaries or there is primary peritoneal cancer.
- May have spread into nearby organs in the pelvis.
- Has spread to the pelvic and/or para-aortic lymph nodes only.
- Has not spread to distant parts of the body.
- Stage IIIA2, the cancer:
- Is in one or both ovaries or there is primary peritoneal cancer.
- Has spread into organs outside the pelvis.
- Is not visible in the abdomen (outside of the pelvis) to the naked eye during surgery, but tiny deposits of cancer are found in the lining of the abdomen when it is examined in the lab.
- Stage IIIB, the cancer:
- Is in one or both ovaries or there is primary peritoneal cancer.
- Has spread into organs outside the pelvis.
- Deposits are large enough for the surgeon to see but are no bigger than 2 centimeters across.
- May or may not have spread to the retroperitoneal lymph nodes, but it has not spread to the inside of the liver, spleen or to distant parts of the body.
- Stage IIIC, the cancer:
- Has spread into the abdomen.
- Deposits are larger than 2 centimeters.
- May or may not have spread to the retroperitoneal lymph nodes, but it has not spread to the inside of the liver, spleen or to distant parts of the body.
Stage IV ovarian cancer
- Stage IVA, the cancer:
- Cells are found in the fluid around the lungs.
- Stage IVB, the cancer
- Has spread to the inside of the spleen or liver, to lymph nodes other than the retroperitoneal lymph nodes, and/or to other organs or tissues such as the lungs and bones.
Recurrent ovarian cancer
The cancer has come back after it has been treated. It may appear in other parts of the body, but it is still considered ovarian cancer. Your doctor may ask for a biopsy to confirm the diagnosis of recurrence.
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