How is ovarian cancer diagnosed?

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.

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