How Is Ovarian Cancer Diagnosed?

A healthcare provider will perform a pelvic exam to check for fluid or lumps around your ovaries to diagnose ovarian cancer. A colonoscopy can also detect ovarian cancer, especially if it's spread.

A healthcare provider may refer you to a gynecologic oncologist (GYO) who specializes in treating cancers that affect the female reproductive system. The GYO will order diagnostic tests and procedures to provide an accurate diagnosis.

Approximately 1.1% of people who have ovaries will receive an ovarian cancer diagnosis in their lifetime. There is no reliable screening test to check for ovarian cancer in people who do not have symptoms.

Medical History

A healthcare provider will ask about your personal and family medical history to learn about your risk factors for ovarian cancer. Be sure to let a healthcare provider know if you have family members with a history of ovarian or breast cancer. These cancers can be hereditary. A healthcare provider will ask if you have symptoms, when they started, and how often they occur.

Pelvic Exam 

A healthcare provider can perform a pelvic exam to check for signs of ovarian cancer. Signs may include fluid in your abdomen and lumps on and around your ovaries. The healthcare provider will place one or two gloved fingers inside the vagina and place their other hand on your abdomen. This helps them feel the size, shape, and position of your ovaries and uterus. 

Detecting ovarian cancer through pelvic exams is rare in the early stages of the disease. Most tumors will be too small to feel.

Imaging 

Imaging tests send forms of energy (e.g., sound waves, radioactive particles) to take pictures of the inside of your body. Examples include an ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) scan. These pictures help a healthcare provider look for tumors on or inside of your ovaries, fallopian tubes, or the peritoneum. This membrane lines the abdominal organs and cavity.

Transvaginal Ultrasound 

A transvaginal ultrasound uses sound waves to produce pictures of the pelvic organs and structures. A healthcare provider will insert a probe into the vagina to get a clear view of the ovaries and uterus. An ultrasound can detect a mass on or around the ovaries. 

An ultrasound can provide an estimated size of the mass and determine if it's solid (tumor) or fluid-filled (cyst). This diagnostic method can also detect fluid in the pelvis. People with more advanced ovarian cancers often have fluid in the pelvis. 

Computed Tomography (CT) Scan

Computed tomography (CT) scans use X-rays to create cross-sectional images of your abdomen or pelvis. A CT scan can help diagnose ovarian cancer, but it's more often used to see if the cancer has spread (metastasized). Ovarian cancer might spread into the lymph nodes, liver, intestines, and other organs. 

A healthcare provider may use a CT scan to guide a needle biopsy. A healthcare provider will move a biopsy needle into a suspected tumor, remove a tissue sample from the mass, and send it to the lab for testing. Testing will determine if the tumor is malignant (cancerous) or benign (non-cancerous).

Magnetic Resonance Imaging (MRI) Scan 

Magnetic resonance imaging (MRI) scans produce cross-section pictures of your body. An MRI scan is a highly accurate way to see if a mass is malignant or benign.

A healthcare provider may not use MRI scans as the first imaging test to detect ovarian cancer (sometimes because of insurance restrictions). MRI scans often provide more detailed information about masses detected on other tests. An MRI is also helpful for examining other body parts, such as the spinal cord and brain, to see if the cancer has spread. 

Blood Tests

A healthcare provider may order blood work to check on your overall health and measure how well your kidneys and liver are functioning. A blood test can also check your blood cell numbers, including your red blood cells, white blood cells, and platelets. 

CA-125 Blood Test

This blood test measures the amount of a protein called cancer antigen 125 (CA-125). CA-125 is a tumor marker found in high levels in about 50% of people with early-stage ovarian cancers. About 92% of people with advanced ovarian cancers have high CA-125 levels.

A CA-125 blood test alone cannot diagnose ovarian cancer. Other health conditions can cause elevated CA-125 levels. These include endometriosis, pelvic inflammatory disease (PID), and uterine fibroids. 

A CA-125 test is often used to monitor the effectiveness of ovarian cancer treatments. It typically means treatment is working if levels go down. This blood test also detects whether the cancer has returned after treatment. 

Other Tumor Marker Blood Tests 

A healthcare provider may order a blood test to look for other tumor markers that cancer cells release into the blood. Elevated tumor markers can help determine the specific type of ovarian cancer you have.

A healthcare provider may look for elevated levels of:

• Alpha-fetoprotein (AFP): The liver makes this protein when its cells are growing. A high AFP level is a potential sign of cancer.
• Human chorionic gonadotropin (hCG): This is a hormone that is commonly linked to pregnancy. hCG can also indicate certain kinds of cancer, particularly cancer in the reproductive organs.
• Inhibin: This marker commonly co-occurs with CA-125.
• Lactate dehydrogenase (LDH): High LDH levels are linked to the presence of cancer cells but are not specific to a type of cancer.

Surgical Biopsy 

A biopsy is the only way to know for certain if a tumor is malignant or benign. A healthcare provider most often does a biopsy after removing a tumor during surgery. They will take a tissue sample from the tumor and send it to the lab. A pathologist (a specialist in body tissues and fluids) will examine the sample under a microscope to look for cancer cells.  

Paracentesis 

Some people with ovarian cancer have ascites, or excessive fluid build-up inside the abdomen. A healthcare provider will take a sample of this abdominal fluid during a paracentesis if surgery is not an option. 

A paracentesis is a procedure in which a needle attached to a syringe is passed through the abdominal wall and into the fluid. A healthcare provider will collect a sample of fluid in the syringe and send it to the lab to check for cancer cells. 

Laparoscopy 

A healthcare provider may obtain a tissue sample during a laparoscopy. This minimally invasive procedure involves making a small incision in the abdomen and inserting a flexible tube with a light and camera (laparoscope). This camera allows a healthcare provider to view the inside of the abdomen and pelvis to look for suspected cancerous masses. 

A second abdominal incision may be made to remove a tissue sample from the tumor or lymph nodes in the pelvis or abdomen. A healthcare provider will send the tissue sample to the lab, where it is analyzed for cancer cells. 

Colonoscopy 

A colonoscopy is most often used to diagnose colorectal cancer. A healthcare provider may also use this diagnostic test in suspected cases of ovarian cancer to see if the cancer has spread. 

The healthcare provider will insert a thin, flexible tube (colonoscope) into the anus, rectum and large intestine. The colonoscope has a small camera on the end, which allows them to see inside the rectum and colon to look for lumps and masses. The healthcare provider can remove a tissue sample and send it to the lab for examination. 

Genetic Testing

A healthcare provider may recommend genetic testing if you have been diagnosed with ovarian cancer. Genetic testing can determine if you inherited certain gene mutations linked to ovarian cancer. About one-fifth of ovarian tumors are thought to be hereditary.

A healthcare provider will typically take a sample of blood, saliva, or cheek cells to complete a genetic test. The most well-known gene changes linked to ovarian cancer are the BRCA1 and BRCA2 mutations. Several other mutations have also been linked to ovarian cancer. 

Inherited mutations can show how your tumor may respond to certain treatments and help guide treatments. Your genetic testing results can also determine if you are at risk of other types of cancers. Your family members can also understand their risk of ovarian cancer. 

Stages of Ovarian Cancer 

An oncologist (cancer specialist) will stage ovarian cancer if diagnostic tests find a malignant tumor. The stage of ovarian cancer refers to how large the tumor is and whether it has spread. Staging helps healthcare providers figure out the best treatments and general prognosis.

There are four stages of ovarian cancer, ranging from early to advanced:

• Stage 1: The cancer is confined to the ovaries or fallopian tubes and has not spread to nearby lymph nodes.
• Stage 2: A healthcare provider has detected cancer in the ovaries or fallopian tubes that has spread into other pelvic organs like the uterus.
• Stage 3: The cancer has spread outside of the pelvis into other areas of the abdomen or abdominal lymph nodes.
• Stage 4: Ovarian cancer has spread outside the pelvis and abdomen to more distant body parts, such as the liver, spleen, or lungs. Cancer cells may be in the fluid around the lungs.

Screening for Related Conditions 

Ovarian cancer symptoms, like abdominal pain, bloating, and frequent urination, are similar to those caused by many other diseases. A healthcare provider can use imaging, blood work, and other tests to rule out other health conditions and provide an accurate diagnosis.

Health conditions that mimic symptoms of ovarian cancer include: 

• Colon cancer
• Ectopic pregnancy 
• Endometriosis 
• Irritable bowel syndrome (IBS)
• Ovarian cysts
• Urinary tract infections
• Uterine fibroids

People with ovarian cancer are at an increased risk of breast cancer, particularly those with hereditary ovarian cancer caused by BRCA1 or BRCA2 gene mutations. Talk to a healthcare provider about how to reduce your risk of breast cancer if you have ovarian cancer. You may need more frequent breast cancer screenings (mammograms), take medication, or have surgery.

A Quick Review

A healthcare provider can diagnose ovarian cancer using a pelvic exam to check for fluid or lumps, imaging tests—including transvaginal ultrasounds, CT scans, and MRIs—blood tests, and tissue biopsy.

Ovarian cancer's early symptoms—like abdominal pain, bloating, and frequent urination—are similar to symptoms of conditions like endometriosis and uterine fibroids. If testing determines you have ovarian cancer, a team of healthcare providers will develop a personalized treatment plan based on the cancer's type and stage.