Ovarian Cancer Diagnosis
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.
Cervical cancer can be detected with a Pap test. Breast cancer can be detected with mammograms and clinical breast exams. But ovarian cancer does not have a routine screening exam to detect it in its earliest stages.
So, how is ovarian cancer typically diagnosed? And, is there anything you can do to prevent it? We asked Travis Sims, M.D., a gynecologic oncologist. Here’s what he had to say.
How is ovarian cancer usually diagnosed?
A tissue biopsy is the only thing that can definitively confirm an ovarian cancer diagnosis. But an initial ovarian cancer diagnosis is often found based on symptoms, such as bloating, fatigue, weight loss, abdominal distention, pelvic pain and feeling full quickly.
Unfortunately, by the time most patients with ovarian cancer see a doctor, 70% to 80% are already at stage III or IV. That’s because the symptoms of ovarian cancer are so vague, and patients often experience them for months before seeking help.
Are there any screening tests for ovarian cancer?
No, we don’t have a standard screening test for ovarian cancer yet the way we do for other types of cancer.
If you see blood in your stool, you can get a colonoscopy to check for colorectal cancer. If you have abnormal vaginal bleeding, you can get a Pap test to look for cervical cancer. If you feel a lump in your breast, you can get a mammogram to rule out breast cancer.
You should also get these screening tests regularly, even if you don't have symptoms, as a part of your routine care. But no screening test currently exists to detect early-stage ovarian cancer.
What about tumor markers like CA-125? Aren’t elevated levels of CA-125 a sign of ovarian cancer?
They can be, but I still wouldn’t call CA-125 a screening test, per se, because getting a routine CA-125 has not been shown to detect ovarian cancer early.
The lifetime risk of developing ovarian cancer in the general population is 1.4%. But in women who carry the genetic BRCA2 mutation, that risk jumps to between 25% and 30%. The BRCA1 mutation pushes it even higher, between 45% and 50%.
So, for women at high risk due to a BRCA mutation, other genetic mutations or other factors, we recommend a twice-yearly pelvic ultrasound and a CA-125 test with a yearly pelvic exam as a part of their assessment.
If tumor markers can’t catch ovarian cancer early, what can they do?
Tumor biomarkers like CA-125 and HE4, or algorithms like ROMA (the Risk of Ovarian Malignancy Algorithm), can be very helpful in assessing the risk of ovarian cancer in someone who is being worked up for a pelvic or ovarian mass.
If someone comes in with a pelvic mass, for instance, an elevated CA-125 level makes me more suspicious that it could be ovarian cancer. If, on the other hand, they have normal CA-125 and HE4 levels and a low ROMA score, the pelvic mass may be benign.
Any time tumor marker levels are elevated, it makes us more suspicious that a pelvic mass might be ovarian cancer. But tumor markers can still be elevated, even if someone doesn’t have ovarian cancer. So, we can’t make an ovarian cancer diagnosis based exclusively on that.
Keep in mind that ovarian cancer itself is inherently rare. Only about 21,000 cases are diagnosed in the United States each year. And most pelvic masses turn out not to be cancer.
Have there been any advances in ovarian cancer diagnosis or screening?
The biggest development right now might be related to the fallopian tubes, rather than the ovaries themselves. More and more data suggest that high-grade serous ovarian cancer, the most common type of ovarian cancer, might originate in the fallopian tubes.
So, there have been a lot of discussions lately about whether all women — high-risk or not — should consider having their fallopian tubes removed during any type of pelvic surgery, assuming they’re done with child-bearing.
Typically, we recommend this procedure — which is called a salpingectomy — in high-risk patients. Now, the discussion is whether it’s worth considering salpingectomies during other, completely unrelated abdominal/pelvic surgeries, such as appendectomies.
A salpingectomy is a relatively low-risk surgery. So, if we can prevent ovarian cancer or reduce its incidence by attacking it at its source, the thinking goes, why shouldn’t we take the opportunity?
What’s the one thing you want people to know about ovarian cancer?
If you have ovarian cancer symptoms — such as fatigue, bloating, abdominal pain, or feeling full quickly — that occur frequently for three weeks or longer, see your doctor.
They could turn out to be nothing. But better safe than sorry. Ovarian cancer is rare, but we don’t want to miss it. Since we don’t have a screening test yet, knowing your body and being your own advocate is still the best way to detect ovarian cancer.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
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.