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 be sure. Diagnosing ovarian cancer starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, reproductive history (such as if you’ve ever been pregnant), and family history of disease. Your healthcare provider will also give you a physical exam.
What tests might I need?
You may have one or more of the following tests:
Tumor marker test: CA-125 blood test
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. He or she uses 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.
This test allows your healthcare provider to see if there’s a cyst or tumor on your ovary, or if there is fluid in your abdomen Your healthcare provider aims sound waves at your ovaries. He or she does this either by putting a small probe into your vagina (transvaginal ultrasound) or aiming them through the skin of your abdomen (abdominal ultrasound). The pattern of the echoes makes a picture on a video screen. This is called a sonogram. The echoes are different for healthy tissues, fluid-filled cysts, and tumors. The test can be uncomfortable, but it isn’t painful. It doesn’t use X-rays. You don’t need to be sedated.
This test makes detailed 3-D pictures of organs and tissues in your pelvis or abdomen. An X-ray machine linked to a computer takes several pictures. You may get contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly.
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 tumor cells. But it also can be elevated in many noncancer conditions. This is called a false positive result. After a diagnosis of ovarian cancer, your healthcare provider may use this blood test to see if you’re responding to treatment. Or the test can be used to check if the cancer has come back.
Unlike many other types of cancer, a biopsy is rarely used to diagnose ovarian cancer before surgery. If a cancer is present and just in the ovary, doing a biopsy breaks the covering of the ovary. This may allow the cancer to spread. Sometimes your healthcare provider may recommend a biopsy of a tumor or lymph node that is not near the ovary. This is done to see if the cancer has spread to another area. A diagnosis of ovarian cancer is often confirmed at the time of surgery. At that time, the surgeon removes the tumor or tumors and takes samples of nearby tissues to find out if the cancer has spread. In a lab, a pathologist looks at the removed tissues to see if cancer is present.
Many experts agree that genetic testing and counseling should be part of diagnosing ovarian cancer. All women who have ovarian cancer should be tested at the time of diagnosis or as soon as possible for certain types of gene changes (mutations). Genetic testing can be done with blood, saliva, or pieces of the tumor. Testing can help guide treatment decisions. Testing might include:
BRCA 1 and BRCA 2 testing
Changes in the BRCA 1 and BRAC 2 genes can mean that certain treatments are more likely to work for epithelial ovarian cancer. These genetic changes might be “germline” mutations. This means they’re inherited and present in all our cells at birth. They can be found in cells from your blood or saliva. This type of gene change can be passed in families (inherited). If you have germline gene mutation, your family (blood relative) may want to discuss their options for getting tested with a qualified genetic counselor. (All genetic evaluations should be done by trained clinicians that know about hereditary cancer syndrome.)
If you don’t have germline BRCA1 and BRCA2 mutations, you can still have mutations that develop after conception in these genes (somatic mutations). These changes are not passed on in families, but happen after birth and found only in the cancer cells.
Tumor testing is done to check for these changes (mutations). The tests are done on a small piece of the tumor. Sometimes, tumor testing isn’t done unless the cancer comes back (recurs) after treatment. this information can help guide further treatment decisions.
DNA mismatch repair testing
Women with clear cell, endometroid, or mucinous ovarian cancer should be offered tumor testing for mismatch repair deficiency (dMMR). To do this, tumor cells are tested to see if there’s a problem in repairing damaged DNA. Normally, when cells grow and divide, DNA is copied to go into the new cells. A system called the DNA mismatch repair system looks for and fixes mistakes made when the DNA divides and makes copies of itself. When this system isn’t working mistakes happen. Over time, these mistakes or mutations can build up and may cause cancer. Results of this test can help guide treatment if ovarian cancer comes back.
Getting your test results
When your healthcare provider has the results of your tests, he or she will contact you with the results. Your provider will talk with you about other tests you may need if ovarian cancer is strongly suspected. Make sure you understand the results and what follow-up you need.