Ovarian Cancer Screening and Diagnosis

Accurate diagnosis and staging for ovarian cancer.

Each year, about 21,000 women are diagnosed with ovarian cancer. The disease is sometimes known as a “silent” cancer. Abnormal cells grow on or around an ovary and eventually form a tumor. That’s when symptoms may start to appear.

When women are diagnosed and treated in the earliest stages of the disease, they have more than a 90 percent chance of survival in five years.

Signs and symptoms of ovarian cancer

Ovarian cancer symptoms can be unnoticeable or quite painful. Symptoms often occur in later stages of the disease and are easily mistaken for gastrointestinal issues or other gynecological conditions.

Early symptoms may include:

• Bloating
• Slight or moderate pain in the pelvic or abdominal area
• Feeling full quickly 
• Frequent urination 

Advanced ovarian cancer symptoms may include:

• Pain in the pelvic or abdominal area
• Pain in the area of the kidneys
• Frequent urination
• Weight loss
• Constipation
• Abdominal swelling

If you have any of these symptoms, schedule a visit with your doctor. Symptoms of early ovarian cancer are sometimes similar to those of ovarian cysts. It is important to have pelvic exams done on the schedule recommended by your gynecologist. Ovarian cancer is easiest to treat when it is detected and diagnosed at an early stage.

Risk factors for ovarian cancer

The exact cause of ovarian cancer is unknown. It occurs most often in women who are postmenopausal, but it can occur in younger women. If your mother, sisters, or other close relatives have had ovarian cancer or breast cancer, you may have a higher risk for developing the disease.

Factors that may increase your risk include:

• Family history of ovarian cancer, breast cancer, endometrial cancer, or colon cancer
• Being 50-75 years old
• Caucasian (white) ethnicity
• Giving birth after the age of 35
• Never giving birth

Diagnosing ovarian cancer

While there is no standardized ovarian cancer testing or screening for patients, your doctor might find a suspicious mass or evidence of cancer through one of the following ways:

Pelvic exam: This is one of the first steps done to evaluate you for suspected ovarian cancer. Your doctor will use a gloved hand to examine the pelvic area for enlarged ovaries, bumps, or fluid.  

Pap test: During a pelvic exam, cells from the cervix are swabbed and then sent to a lab to be analyzed for cancer. 

Blood test: A blood test may be done to measure the amount of a certain protein in the blood called CA-125. This protein is normally present in the body, but it increases if cancer is present. Additional tests may be required because elevated rates of CA-125 may be caused by conditions such as menstruation, fibroid cysts, and pelvic inflammatory disease.

Imaging: Several types of imaging may identify ovarian cancer.

• Pelvic ultrasound: Images of the pelvic organs are obtained by using sound waves. A non-greasy gel is applied to the skin and a hand-held probe (transducer) is moved across the abdomen. In pregnant women, ultrasound is used to check the health of an unborn baby. In women suspected of ovarian cancer, ultrasound can help diagnosis pelvic masses, fibroids, and other ovarian problems. 
• Transvaginal ultrasound: This exam also uses sound waves to obtain images of the ovaries, uterus, and lining of the uterus. Either you or a sonographer will place a probe covered with a sheath and non-greasy gel in your vagina. The sonographer will move the probe to obtain the best images. You may feel some pressure. If you feel pain, tell the sonographer.
• Computed tomography (CT): This is an x-ray that creates cross-sectional images of the pelvic area. It may find enlarged nodes or signs that the cancer has spread to other organs.
• Magnetic resonance imaging (MRI): Strong magnets are used to make images and help diagnose cancer. No radiation is used.
• Positron emission tomography (PET) scan: This scan may be used to determine if ovarian cancer has spread to other organs.
• Colonoscopy: If you have symptoms that the cancer has moved into your colon, your doctor will want you to have a colonoscopy. You will be sedated for this procedure. A thin, flexible and lighted tube with a small video camera on the end is inserted through the anus. During the procedure, the doctor can remove any cancerous cells.
• Barium enema x-ray: For this x-ray, liquid is inserted into your rectum through a narrow tube and then images are taken of the colon. A specially trained doctor called a radiologist will be able to see if ovarian cancer has spread to the colon.
• Chest x-ray: In some cases, a chest x-ray may be required to determine if ovarian cancer has spread to the chest.
• Laparoscopy: This procedure involves making a small incision in the lower abdomen and inserting a thin, lighted tube which sends images to a video monitor. This can help your doctor confirm the stage of the cancer, plan surgery, or other treatments. 

Biopsies

Biopsy during surgery: Taking a sample of a suspicious tumor is the only way to determine if an ovarian tumor is cancerous. To reduce the chance of spreading the cancer, the suspicious tumor is surgically removed and then samples of the cells are examined under a microscope. 

Biopsy during laparoscopy: If you cannot undergo surgery because the cancer has spread or you have other health issues, a sample of the tumor cells may be taken during a laparoscopy. During this procedure, a small incision is made in the abdomen and a thin lighted tube is inserted. A needle is placed through the tube and directly into the tumor while the surgeon is guided by images on a monitor. A small sample of cells are suctioned out of the tumor and sent to the lab for analysis.

Paracentesis: This procedure is used to remove fluid buildup inside the abdomen and diagnose cancer. The skin on the abdomen is numbed and a needle with a syringe draws out fluid from the abdominal cavity. The fluid is analyzed in a lab to determine if it contains cancer cells. 

Genetic testing for ovarian cancer

Our Cancer Genetics Program provides genetic counseling and testing to people with a personal and/or family history of cancer. 

If women in your family or extended family have had cancer of the breast, colon, uterus, or ovaries, you may have a hereditary risk for ovarian cancer. A blood test or saliva sample can show if you have inherited from your mother or father certain genes with abnormal changes called mutations. Abnormal genes – BRCA1, BRCA2, and PALB2 – cause about five to 10 percent of cancer cases. Other cancers are random occurrences, or they are caused by environmental factors, such as smoking. 

Stages of ovarian cancer

Your doctor will want to find exactly where the cancer is located and how much of it is in your body. This process is called staging. For ovarian cancer, the staging process usually involves surgery to remove the uterus, ovaries, and fallopian tubes. The fatty layer of tissue covering the abdomen may be removed also. 

Biopsies may be taken from the lymph nodes in the pelvis and abdomen. After surgery, the tissue and fluid that has been removed will be examined in a lab by a specially trained physician called a pathologist. The pathologist will help identify the stage of cancer. Then your gynecologist and the tumor board will determine additional treatment options. 

There are four stages of ovarian cancer: 

• Stage 1: Cancer is inside one or both ovaries or one or both fallopian tubes. The cancer is not on the outside surface of the ovaries and fallopian tubes.
• Stage 2: Cancer is inside one or both ovaries or fallopian tubes and has spread to surrounding organs, such as the rectum, bladder, uterus, or sigmoid colon.
• Stage 3: Cancer is inside one or both ovaries or fallopian tubes and has spread to surrounding organs and the lymph nodes or lining of the abdomen.
• Stage 4: Cancer has spread to distant organs, such as the spleen, lungs, liver, or other organs outside the abdominal area.