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Tests and diagnosis
By Mayo Clinic staff
Because no standardized screening test exists to reliably detect ovarian cancer, doctors don't recommend screening for this type of cancer for most women. If you have a high risk of ovarian cancer, you need to have a careful discussion with your doctor about the risks and benefits of undergoing screening tests. While you may wonder what harm could come from a screening test, such tests can lead to unnecessary operations or other procedures that have significant side effects. Along with the potential complications of surgery, unnecessary procedures can cause anxiety, loss of work and substantial financial costs.
Several screening tests for ovarian cancer are commercially available, but none has been proved to lead to an early diagnosis that improves outcome. Additionally, these tests may lead to false-positives, which may subject women to unnecessary procedures and worry.
If your doctor suspects your symptoms suggest the presence of ovarian cancer, he or she may recommend one or more of the following tests to diagnose ovarian cancer:
- Pelvic examination. Your doctor examines your vagina, uterus, rectum and pelvis, including your ovaries, for masses or growths. If you've had your uterus removed (hysterectomy) but still have your ovaries, continue getting regular pelvic exams.
- Ultrasound. Ultrasound uses high-frequency sound waves to produce images of the inside of the body. Pelvic ultrasound provides a safe, noninvasive way to evaluate the size, shape and configuration of the ovaries. If a mass is found, however, ultrasound can't reliably differentiate a cancerous growth from one that's not cancerous. Ultrasound can also detect fluid in your abdominal cavity (ascites), a possible sign of ovarian cancer. Because ascites develops in many conditions other than ovarian cancer, however, its presence necessitates more testing.
- CA 125 blood test. CA 125 is a protein made by your body in response to many different conditions. Many women with ovarian cancer have abnormally high levels of CA 125 in their blood. However, a number of noncancerous conditions also cause elevated CA 125 levels, and many women with early-stage ovarian cancer have normal CA 125 levels. Because of this lack of specificity, the CA 125 test isn't used for routine screening in average-risk women and is of uncertain benefit in high-risk women.
Other diagnostic tests may include computerized tomography (CT) and magnetic resonance imaging (MRI), which both provide detailed, cross-sectional images of the inside of your body. Your doctor may also order a chest X-ray to determine if cancer has spread to the lungs or to the pleural space surrounding the lungs, where fluid can accumulate. If fluid is present, a needle may be inserted into the space to remove it. The fluid is then checked in the laboratory for cancer cells.
Confirming the diagnosis
If these tests suggest ovarian cancer, you'll need an operation to confirm the diagnosis. In a surgical procedure called laparotomy, a gynecologic oncologist makes an incision in your abdomen and explores your abdominal cavity to determine whether cancer is present. The surgeon may collect samples of abdominal fluid and remove an ovary for examination by a pathologist.
In certain cases, a less invasive surgical procedure called laparoscopy may be used. Laparoscopy requires only a couple of small incisions, through which a lighted instrument is inserted, along with small tools used to perform the surgery. Laparoscopy may be used if a surgeon wants to remove a tissue mass to determine whether it's cancerous before proceeding with a more invasive operation.
If ovarian cancer is confirmed, the surgeon and pathologist identify the type of tumor and determine whether the cancer has spread. This will help determine the stage of the disease. The surgeon usually will then need to extend the incision so that he or she can perform a more extensive operation to remove as much cancer as possible. It's important that this type of surgery be performed by a doctor specifically trained to treat gynecologic cancers.
Before you have a diagnostic operation, talk with your doctor about what your treatment options will be if you turn out to have a noncancerous abnormality on your ovary. If you're near or past menopause, your doctor may recommend removing both of your ovaries to decrease your risk of ovarian cancer.
Staging your cancer
Ovarian cancer is classified in stages I through IV, with stage I being the earliest and stage IV, the most advanced. Staging is determined at the time of surgical evaluation of the disease:
- Stage I. Ovarian cancer is confined to one or both ovaries.
- Stage II. Ovarian cancer has spread to other locations in the pelvis, such as the uterus or fallopian tubes.
- Stage III. Ovarian cancer has spread to the lining of the abdomen (peritoneum) or to the lymph nodes within the abdomen. This is the most common stage of disease identified at the time of diagnosis.
- Stage IV. Ovarian cancer has spread to organs beyond the abdomen.
- Detailed guide: Ovarian cancer. American Cancer Society. http://documents.cancer.org/114.00/114.00.pdf. Accessed Aug. 20, 2008.
- Goff B. Early detection of ovarian cancer: Role of symptom recognition. http://www.uptodate.com/home/index.html. Accessed Aug. 19, 2008.
- Chan LM, et al. Epithelial ovarian cancer: Clinical manifestations, diagnostic evaluation, staging, and histopathology. http://www.uptodate.com/home/index.html. Accessed Aug. 19, 2008.
- Chan LM, et al. Epithelial ovarian cancer: Pathogenesis, epidemiology, and risk factors. http://www.uptodate.com/home/index.html. Accessed Aug. 19, 2008.
- Zhou B, et al. Hormone replacement therapy and ovarian cancer risk: A meta-analysis. Gynecologic Oncology. 2008;108(3): 641-651
- Carlson KJ, et al. Patient information: Ovarian cancer screening. http://www.uptodate.com/home/index.html. Accessed Aug. 19, 2008.
- Ovarian cancer: Treatment guidelines for patients. National Comprehensive Cancer Network and the American Cancer Society. http://www.cancer.org/downloads/CRI/NCCN_Ovarian_Cancer_2007.pdf. Accessed Aug. 19, 2008.
- Herzog TJ, et al. Patient information: Ovarian cancer treatment. http://www.uptodate.com/home/index.html. Accessed Aug. 19, 2008.
- Benefits of good nutrition. American Cancer Society. http://www.cancer.org/docroot/MBC/content/MBC_6_2X_Benefits_of_nutrition_during_treatment.asp?sitearea=MBC. Accessed Aug. 24, 2008.
- Muto MG, et al. Risk reducing salpingo-oophorectomy in women at high risk of epithelial ovarian cancer. http://www.uptodate.com/home/index.html. Accessed Aug. 19, 2008.
- Timothy Moynihan (expert review). Mayo Clinic, Rochester, Minn. Aug. 28, 2008.
