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Learning that you may need testing for ovarian cancer can feel overwhelming and scary. It’s natural to have questions about what to expect and what the results might mean for you. Understanding how doctors diagnose ovarian cancer can help you feel more informed and prepared as you move forward.
Ovarian cancer may not cause symptoms in the early stages. If you have symptoms that indicate ovarian cancer, your doctor will recommend a series of imaging, blood, and genetic tests to determine the cause. Here, learn more about the different types of tests and how they help diagnose ovarian cancer.
Currently, there are no reliable screening tests available to detect ovarian cancer early. However, there are a number of tests that together can diagnose ovarian cancer. People who are at a high risk of developing ovarian cancer should be screened regularly.
Whether you’re at a routine medical appointment or you’ve made an appointment due to concerning symptoms, your doctor will perform a routine physical exam to check your general health and to look for any signs of disease or anything unusual.
A pelvic exam is a comprehensive exam of the vagina, cervix, uterus, ovaries, fallopian tubes, and rectum. The doctor will insert a speculum into the vagina to look at it and the cervix. They will feel the shape, size, and position of the uterus and ovaries. They will also look for any abnormal swelling or lumps. A Pap test may be taken during this time, but it’s only used to diagnose cervical cancer, not ovarian cancer.
Doctors use imaging tests to help detect ovarian cancer. If cancer is found, they’ll check how large the tumors are and whether the cancer has spread beyond the ovaries. This information helps determine the stage of ovarian cancer, which is key to deciding the best treatment plan.
Ultrasound imaging is the most common technique used to detect ovarian cancer. An ultrasound transducer is placed on the abdomen above the ovaries, or with a transducer placed into the vagina, and sound waves bounce off the ovaries to form a picture.
Computed tomography (CT) scans may be performed to stage an ovarian cancer diagnosis. This type of imaging gives the doctor a detailed look inside the body from different angles. CT scans are best at imaging large tumors and enlarged lymph nodes and detecting signs of metastasis (spread of the cancer).
Magnetic resonance imaging (MRI) scans can also be used to create detailed images of the body. MRI scans are not used as often to find and diagnose ovarian cancer. However, they’re especially helpful in examining the spinal cord and brain to detect signs of metastasis.
A positron emission tomography (PET) scan is a test that may be done after diagnosis. It can show whether cancer has spread to other parts of the body, including your lymph nodes.
The only way to officially diagnose cancer is through a biopsy. This procedure removes a piece of a suspected tumor, which is sent to a pathologist who examines the cells under a microscope. Biopsies can be taken during surgery, but sometimes smaller samples can be taken before the surgery to confirm the diagnosis.
In some cases, a biopsy can be taken during a laparoscopic procedure, where doctors use small instruments attached to a laparoscope (a thin, flexible tube) to remove potentially cancerous tissue. An ovarian needle aspiration can also be performed, which involves placing a needle directly into the tumor through the abdomen. This method is used only in cases where the person cannot have surgical procedures, or if there’s limited concern that a biopsy could result in the cancer spreading.
One common blood test used to diagnose ovarian cancer is the detection of cancer antigen 125 (CA-125). Individuals with ovarian cancer often have elevated levels of this protein; however, some people may never have elevated CA-125 levels.
In addition to ovarian cancer, high CA-125 levels can indicate:
Individuals who are at a high risk of developing ovarian cancer may have a CA-125 blood test done periodically. Risk factors for developing ovarian cancer include:
You may also need additional blood testing depending on which subtype of ovarian cancer you have. Some types of ovarian cancer cells make specific compounds and release them into the blood. By measuring these compounds, your doctor may be able to tell which subtype you have.
For example, germ cell tumors sometimes produce certain proteins, including:
If your doctor detects these proteins in your blood, it can help confirm that you have a germ cell tumor. Additionally, doctors may continue to test for these proteins over the course of your treatment to see whether a tumor is shrinking or coming back.
Genetic testing is important for better understanding a person’s diagnosis, treatment, and outlook. However, genetic testing can also be used to predict someone’s risk of ovarian cancer before they receive a diagnosis. Identifying these mutations can help doctors predict the course of the disease and decide which treatments are most likely to be effective. Genetic testing is done via a blood sample.
BRCA1 and BRCA2 mutations are often linked to breast cancer, but they’re also found in ovarian cancer. If you have a BRCA1 or BRCA2 mutation, you may respond well to a class of drugs known as poly (ADP-ribose) polymerase inhibitors — or PARP inhibitors — which are used to treat ovarian cancer. People with mutations in the BRCA genes are much more likely to develop ovarian cancer.
Another mutation that occurs, but rarely, in ovarian cancer is in the NTRK gene. This mutation is called NTRK gene fusions and can lead to abnormal cell growth. Fortunately, targeted drug therapies are available to treat cancers with NTRK mutations and can be prescribed by a gynecologic oncologist.
Individuals who have been diagnosed with endometrioid, mucinous, or clear cell subtypes of ovarian cancer might have testing done to identify gene changes known as microsatellite instability (MSI). Genetic testing may also be performed to look for changes in mismatch repair (MMR) genes.
Changes in MSI, MMR, or both can indicate a condition known as Lynch syndrome (hereditary nonpolyposis colorectal cancer). People with Lynch syndrome are more likely to develop other cancers, such as colorectal, uterine, stomach, and liver cancer.
If a family member has had ovarian cancer linked to one of these gene changes, or if you have other risk factors for ovarian cancer, your doctor may refer you to a genetic counselor for testing. If you discover you have a gene mutation, your doctor or a genetic counselor can help you determine proactive steps to protect your health and help you share the information with family members who may also be at risk.
On MyOvarianCancerTeam, people share their experiences with ovarian cancer, get advice, and find support from others who understand.
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