Diagnosis of ovarian cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing ovarian cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for ovarian cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as ovarian cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of ovarian cancer.

The following tests are usually used to rule out or diagnose ovarian cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest ovarian cancer
• breast cancer
• Lynch syndrome (also called hereditary non-polyposis colorectal cancer, or HNPCC)
• pregnancies
• hormone replacement therapy
• smoking
• exposure to asbestos

Your doctor may also ask about a family history of:

• ovarian or breast cancer
• Lynch syndrome (also called hereditary non-polyposis colorectal cancer, or HNPCC)
• infertility
• risk factors for ovarian cancer
• other cancers, such as breast, uterine and colorectal cancers

A physical exam allows your doctor to look for signs of ovarian cancer. During a physical exam, your doctor may:

• do a pelvic and rectal exam to check the uterus, vagina, ovaries, fallopian tubes, bladder and rectum for any unusual changes
• feel the abdomen for lumps, bloating or enlargement of organs such as the liver or spleen

Find out more about physical exams and pelvic exams.

An ultrasound uses high-frequency sound waves to make images of parts of the body. A pelvic or transvaginal ultrasound may be done to look for ovarian cancer. With the transvaginal ultrasound, the ultrasound wand or probe is placed into the vagina and aimed at the ovaries instead of placing the probe on the surface of the abdomen. Ultrasounds are used to:

• find an ovarian tumour and see if it is a solid tumour or a fluid-filled cyst
• see the shape and size of the ovary and how it looks inside
• evaluate abnormalities in other organs in the pelvis
• check for a buildup of fluid in the abdomen

Find out more about ultrasound.

Tumour markers are substances found in the blood, tissues or fluids removed from the body. Tumour marker tests are generally used to check your response to cancer treatment and watch for recurrences. They can also be helpful when diagnosing ovarian cancer.

The following tumour markers may be measured for ovarian cancer.

Cancer antigen 125 (CA125) may be higher in women with ovarian cancer, benign conditions and other cancers.

Carcinoembryonic antigen (CEA) may be higher in women with ovarian cancer and benign conditions.

Human chorionic gonadotropin (HCG or b-HCG) may be higher in young women with ovarian germ cell tumours.

Alpha-fetoprotein (AFP) may be higher in young women with ovarian germ cell tumours.

Find about more about tumour marker tests.

A CBC measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to provide information about your general health, check for anemia from long-term vaginal bleeding and to provide a baseline to compare with future CBCs during and after treatment.

Find out more about a complete blood count (CBC)..

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities.

Lactate dehydrogenase (LDH) may be measured in women with ovarian cancer. Higher levels may indicate an ovarian germ cell tumour.

Hormones, such as estrogen and testosterone and inhibin, may be at higher levels than normal in some women with ovarian stromal tumours.

Find out more about blood chemistry tests.

A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to:

• assess the pelvis, abdomen and lymph nodes around the ovaries
• see if cancer has spread to other organs or tissues
• guide the needle when doing a biopsy of an area of suspected metastasis

Find out more about CT scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-D pictures.

An MRI is used to:

• assess the pelvis, abdomen and lymph nodes around the ovaries
• see if cancer has spread to other organs or tissues
• guide the needle when doing a biopsy of an area of suspected metastasis

Find out more about MRIs.

During a laparoscopy, the doctor makes a small cut (incision) in the abdomen and places a thin tube (called a laparoscope) into the abdominal cavity. Surgical instruments can be passed through the laparoscope to remove small pieces of tissue. Laparoscopy is done to:

• check for abnormal growths and remove samples of tissue from the ovaries and other organs in the abdomen
• remove small tumours or cysts
• help confirm the stage of a cancer
• plan surgery or other treatments

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from the pathologist will show whether or not cancer cells are found in the sample.

Biopsies for ovarian cancer are often done during surgery called a laparotomy. This surgery is used to diagnose, stage and treat ovarian cancer, often all at the same time. The surgeon makes a large cut (incision) in the abdomen to examine all organs in the abdominal cavity. During this surgery, the surgeon usually removes the entire tumour and also removes tissue samples from different parts of the pelvis and abdomen to detect for any spread to those areas. The samples are sent to the lab to help stage the cancer. This is called surgical staging.

Find out more about biopsies.

A paracentesis is a procedure in which a hollow needle or tube is inserted through the skin and into the abdominal cavity. This procedure is done to remove symptomatic buildup of fluid in the abdomen (ascites). The fluid is examined for cancer cells.

An x-ray uses small doses of radiation to make an image of parts of the body on film. It is used to look for signs of fluid around the lungs (pleural effusion) that could be caused by ovarian cancer that has spread to the lungs.

Find out more about x-rays.

A colonoscopy may be done to see if the ovarian cancer has spread to the colon or to rule out colon cancer.

Find out more about colonoscopies.

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-D colour images of the area being scanned.

A PET scan may be used to find ovarian cancer that has come back or has spread to other organs or tissues.

Find out more about PET scans.

To make the decisions that are right for you, ask your healthcare team questions about diagnosis.