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Diagnosis

Unlike a Pap test for cervical cancer or a mammogram for breast cancer, there is currently no reliable test to screen healthy women for ovarian cancer. Diagnosing ovarian cancer may include any or all of the procedures below:

Pelvic Exam

In a pelvic exam, the doctor inserts one or two gloved fingers into the vagina and presses on the lower abdomen with the other hand. Sometimes this exam involves placing a finger in the vagina and rectum at the same time to feel structures deeper in the pelvis. A pelvic exam helps determine if there is a mass on either side of the uterus, which may indicate the presence of an ovarian tumor. If ovarian cancer is diagnosed, the doctor will also need to check to see whether the cancer has spread to other parts of the body.

CA-125 Blood Test

This blood test measures the level of a protein, CA-125, which is produced by ovarian cancer cells. CA-125 is known as a tumor marker because it is usually present at higher levels in women with ovarian cancer. CA-125 is most reliable when used to detect recurrent disease in women previously treated for ovarian cancer. Doctors generally look at the trend in CA-125 levels over time rather than individual test results. If the level is high before treatment, it can be used to monitor the effectiveness of chemotherapy. These levels can help predict treatment outcomes for fallopian tube cancer and primary peritoneal cancer, as well as ovarian cancer.

The CA-125 test alone cannot diagnose ovarian cancer, and is currently not effective in screening healthy women. A high level of CA-125 does not necessarily mean ovarian cancer is present. Conditions such as abdominal inflammation, recent surgery, fibroids, endometriosis, ectopic pregnancy or a ruptured cyst can all cause an increase in CA-125. At the same time, low levels of CA-125 do not mean you are cancer-free, since some types of ovarian cancer produce only low levels of CA-125 or none at all.

Transvaginal Ultrasound

In this procedure, a wand-shaped scanner is inserted into the vagina. It sends out sound waves and receives echoes as they bounce off the ovaries, creating electronic images viewed by the doctor on a small screen. A radiologist interprets the pictures and reports the findings to the doctor. Transvaginal ultrasound can show any growths on or near the ovaries, although doctors cannot determine whether they are cancer just by looking at them. This procedure is usually performed in a doctor's office.

Surgical Biopsy

The only way to confirm a diagnosis of ovarian cancer is for a pathologist to look at the ovarian tissue. A sample of tissue is usually obtained during surgery. Read more about surgery in the Treatment section.

Genetic Testing

Women at high risk for ovarian cancer because of personal or family history may be encouraged by their doctor to undergo additional testing, which may include genetic tests. Many women find this information helpful in making important decisions about prevention strategies for themselves and their children.

There are benefits and risks with genetic testing, so women should discuss it with their doctor. Blood tests are available to determine the presence of the BRCA1 or BRCA2 genes, which also cause breast cancer, and for genes involved in Lynch syndrome, an inherited colon cancer syndrome. In women believed to be carrying one of these mutations, a blood test may help determine whether they are at high risk for ovarian cancer (as well as breast, uterine or colon cancer, depending on the gene).

The stage of ovarian cancer describes the extent to which the tumor has spread outside the ovary to nearby tissues and other parts of the body. Staging is done during the surgical biopsy, and generally requires removing lymph nodes, samples of tissue from the diaphragm and other abdominal organs, and fluid from the abdomen. When diagnosed early (Stage I), a woman has a 95 percent chance of being cured. However, only 25 percent of ovarian cancer cases are diagnosed in early stages. Ovarian cancer staging is as follows:

The stage of ovarian cancer describes the extent to which the tumor has spread outside the ovary to nearby tissues and other parts of the body. Staging is done during the surgical biopsy, and generally requires removing lymph nodes, samples of tissue from the diaphragm and other abdominal organs, and fluid from the abdomen. When diagnosed early (Stage I), a woman has a 95 percent chance of being cured. However, only 25 percent of ovarian cancer cases are diagnosed in early stages. Ovarian cancer staging is as follows:

Stage I: The cancer is limited to the ovary or ovaries.

Stage IA: The tumor is limited to the inside of one ovary.

Stage IB: The tumor is limited to the inside of both ovaries.

Stage IC: The tumor is limited to one or both ovaries. In addition, it appears on the surface of the ovary, a fluid-filled capsule has burst or cancer cells are found in abdominal fluid.

Stage II: The cancer is in one or both ovaries and has spread to other parts of the pelvis.

Stage IIA: The tumor has spread to the uterus, fallopian tubes or both.

Stage IIB: The tumor has spread to the bladder, rectum or colon.

Stage IIC: The tumor has spread to any of the above. Also, it appears on the surface of the ovary, a fluid-filled capsule has burst, or cancer cells are found in abdominal fluid.

Stage III: The cancer is in one or both ovaries and has spread to nearby lymph nodes or other abdominal organs, not including the liver.

Stage IIIA: The tumor has spread to the lining of the abdomen but cannot be seen. The cancer has not spread to the lymph nodes.

Stage IIIB: The cancer has spread into the abdomen and is visible (less than two centimeters, about 3/4 of an inch, in size). The cancer has not spread to the lymph nodes.

Stage IIIC: The cancer has spread into the abdomen and the deposits measure larger than two centimeters. The cancer has spread to the lymph nodes.

Stage IV: The cancer has spread to the lung, liver or other distant organs.

Recurrent ovarian cancer: The cancer has come back after it has been treated. It may appear in other parts of the body, but is still considered ovarian cancer.