Ovarian Cancer: Diagnosis

How is ovarian cancer diagnosed?

If your healthcare provider thinks you might have ovarian cancer, you will need certain exams and tests to make sure. Diagnosing ovarian cancer starts with your healthcare provider asking you questions. You'll be asked about your health history, your symptoms, and risk factors. You'll be asked about your reproductive history, such as if you've ever been pregnant. And you'll be asked about any family history of disease. Your healthcare provider will give you a physical exam.

What tests might I need?

You may need one or more of these tests:

• Pelvic exam

• Ultrasound

• CT scan

• Tumor marker test (CA-125 blood test)

• Biopsy

• Genetic testing

Pelvic exam

This is often the first exam done. It allows your healthcare provider to feel for any abnormal lumps (masses) or other problems. During a pelvic exam, you lie on your back on an exam table, with your feet in stirrups and your legs apart. Your healthcare provider puts 1 or 2 fingers of a gloved hand inside your vagina. They use the other hand to press on your lower belly (abdomen) to feel for masses. Your healthcare provider may also put a finger in your rectum to feel for anything abnormal that might suggest that the cancer has spread.

Ultrasound

This is also called a sonogram. It allows your healthcare provider to look for cysts or tumors on your ovaries. It also shows if there's fluid in your abdomen. A small, wand-like probe is put into your vagina (transvaginal ultrasound). Or the probe is pressed against the skin of your abdomen (abdominal ultrasound). The probe sends out the sound waves. They bounce off your inside tissues, and the pattern of the echoes makes a picture on a video screen. The echoes change for healthy tissues, fluid-filled cysts, and tumors. The test can be uncomfortable, but it doesn’t hurt. It doesn’t use X-rays.

CT scan

This test makes detailed 3-D pictures of organs and tissues in your pelvis, abdomen, or both. An X-ray machine linked to a computer takes many pictures. You may get contrast dye by mouth, as a shot, or both into your arm or hand. The dye helps your organs and tissues show up more clearly.

Tumor marker test (CA-125 blood test)

This blood test shows how much of a protein called CA-125 is in your blood. A high (elevated) CA-125 may be a sign of ovarian cancer. But it also can be elevated in many noncancer conditions. After a diagnosis of ovarian cancer, this blood test might be used to see if the cancer responding to treatment. If it is, the amount in your blood should go down. This test can also be used to see if the cancer has come back after treatment.

Biopsy

Unlike many other types of cancer, a biopsy is rarely needed to diagnose ovarian cancer before surgery. If the cancer is only inside the ovary, doing a biopsy breaks the covering of the ovary. This may allow the cancer to spread. Sometimes a biopsy of a tumor or lymph node that's not near the ovary is done. This can show if the cancer has spread beyond the ovary. Sometimes surgery might be delayed if the cancer has greatly spread beyond the ovary. In this case, you may have chemo first. A diagnosis of ovarian cancer is often confirmed at the time of surgery. The surgeon removes the tumor or tumors. They also take tiny pieces (samples) of nearby tissues to find out if the cancer has spread. These tissues are sent to a lab, where they're checked for cancer.

Genetic testing

Many experts agree that genetic testing and counseling should be part of diagnosing ovarian cancer. All people should be tested at the time of diagnosis or soon after. The testing looks for certain gene changes (mutations). This testing can be done with blood, saliva, or pieces of the tumor. Testing can help guide treatment decisions.

Getting your test results

Ask your healthcare provider when your test results will be back. Also ask how you will get the results. Will it be a phone call? Do you need an appointment?

If cancer is found, your provider will talk with you about other tests you may need. Make sure you understand the results and what your next steps should be.