Making the Diagnosis
Unfortunately, no reliable screening test exists for ovarian cancer, and approximately 80% of ovarian cancers are diagnosed in advanced stages.
If ovarian cancer is suspected, the following tests may be performed:
- physical examination, including a pelvic and abdomen exam
- ultrasound - transvaginal/pelvic and abdominal - a test used to create a "picture" of the pelvic and abdominal contents
- CT scans (computed tomography), or MRI (magnetic resonance imaging), or bone scans to see if the cancer has spread
- blood tests to check your blood cells, organ function (e.g., kidney, liver), and to test for a tumor marker called cancer antigen 125 (CA125)
A CA-125 test uses an antibody to detect a chemical produced at higher levels by ovarian cancer cells. However, it is only elevated in approximately 50% of cases of early-stage ovarian cancer and can also be present in noncancerous conditions, especially in premenopausal women. In instances where ovarian cancer is suspected, the CA-125 may assist in the diagnosis in combination with other tests.
If the results of these tests suggest ovarian cancer, additional tests will be required to confirm the diagnosis. However, it is important to keep in mind that not all ovarian tumors are cancerous - many turn out to be benign (noncancerous).
To confirm a diagnosis of ovarian cancer, cancer tissue or cancer cells must be obtained by one of the following procedures:
- taking a sample of abdominal fluid if it is present: This is usually a simple procedure done with local anesthetic. Pathologists then examine the fluid for cancer cells.
- obtaining a biopsy of the tumor: This is a fairly simple procedure and is done under local anesthetic, usually with CT or ultrasound guidance.
- undergoing a laparotomy: This is a surgical exploration of the abdomen to help confirm a diagnosis and, if need be, to also remove all evidence of the cancer as the first step in treatment.
If ovarian cancer is confirmed, the above tests also help determine the stage of ovarian cancer. Ovarian cancer has the following stages:
- stage 1: confined to one or both ovaries
- stage 2: spread to other areas in the pelvis (e.g., fallopian tubes, uterus)
- stage 3: spread to the organs or lymph nodes within the abdomen
- stage 4: spread to organs beyond the abdomen
From a biopsy, the grade of the tumor can be determined. The grade describes how abnormal the tumor cells appear under a microscope. Ovarian cancer can be grade 1, 2, or 3. Higher grade tumors appear more abnormal under a microscope.