Diagnosing Ovarian Cancer
Initial tests may be run by your gynecologist or another medical professional you see for female reproductive health.
In addition to a physical exam where your doctor will check your general health and learn more about your personal and family medical history, it is likely that you will have one or more of the following tests:
Abdominal-pelvic exam: During this exam, your doctor feels the ovaries and nearby organs for any unusual changes, such as a mass. Since Pap tests only diagnose cervical cancer, the doctor might not include that in this diagnostic exam.
Blood tests: Your doctor may order a specific blood test that measures a substance called CA-125, which is found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer or other conditions. While there are other tumor marker tests available, they have not been found effective in the early detection of ovarian cancer.
Transvaginal ultrasound: The ultrasound device uses sound waves that people cannot hear to create a picture of the ovaries and surrounding tissues. For a better view of the ovaries, the probe is inserted in the vagina and aimed at the ovaries and uterus.
CT and/or MRI Scan: Computerized tomography (CT) and magnetic resonance imaging (MRI) scans are two procedures that provide more detail than conventional x-rays. Both scans are similar in the fact that they show cross-sectional pictures of the body, however, they differ in their techniques. To get a series of pictures, CT scans use multiple x-rays, taken at different angles, while MRIs use magnetic fields and radio frequencies.
PET Scan: The positron emission tomography scan (PET) is an imaging test used to find malignant (cancerous) tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein and then the PET scanner makes a picture of where the glucose is being used in the body. Since cancers use glucose at a higher rate than normal tissues, malignant tumor cells will show up brighter in the picture.
Testing the Ovarian Tumor Cells
If a tumor is detected on or near the ovaries and surgery is performed to remove it, the doctor is likely to have a pathologist look at the cells under a microscope to determine if cancer is present. This is called a biopsy.
While other tests can suggest the presence of cancer, only a biopsy can make a definitive diagnosis. In most cases this is only done if there are tumors removed. Performing a separate procedure just to biopsy suspected ovarian cancer tumors could potentially spread the cancer cells.
During the biopsy tests are also run for biomarkers. This will help identify specific genes, proteins, and other factors that are considered to be unique to the tumor. Genetic changes in the tumor cells are called somatic mutations. Additionally they may also run genetic testing for inherited, or germline mutations, if that wasn’t already performed. Somatic tumor testing is highly encouraged for women who have been diagnosed with ovarian cancer but do not carry a germline mutation.
After your diagnostic tests are completed, your doctor will review all of the results with you. If the diagnosis is cancer, these test results help your doctor describe the cancer. This process is called staging.