How Is Ovarian Cancer Diagnosed?

Reviewed by: HU Medical Review Board | Last reviewed: May 2021

Early diagnosis of ovarian cancer is important. The earlier the diagnosis is made, the more effective treatments are.

If your doctor thinks you may have ovarian cancer, they will likely use a variety of tests and tools to help make an accurate diagnosis. Some of the tests can rule out other conditions that can also cause some of the general symptoms of ovarian cancer.

If your doctor will not order certain tests despite symptoms you are having, see another doctor for a second opinion.

Medical history

A medical history usually includes written and verbal questions to help your doctor understand your symptoms and how long you have been experiencing them. Some of the questions will also cover possible risk factors for ovarian cancer, including your family history.1

Pelvic exam

A pelvic exam allows your doctor to check for lumps or changes around the ovaries and in the pelvic area. Your doctor can also observe any bloating you might be having since this is a common symptom of ovarian cancer.1,2

If your doctor thinks you have ovarian cancer based on your symptoms and/or pelvic exam, they will order tests for more information. You will also need to see a doctor or surgeon who specializes in treating women with ovarian cancer. A gynecologic oncologist is a doctor who is specially trained in treating cancers of the female reproductive system. Treatment by a gynecologic oncologist has been shown to help women with ovarian cancer live longer.2

Imaging tests

There are many kinds of imaging tests that can help your doctor make an accurate diagnosis. Imaging tests can show doctors whether a pelvic mass is present. These tests can include ultrasounds, PET scans, or CT scans. MRI is not typically used to diagnose ovarian cancer. However, it can be helpful if your doctor thinks cancer has spread to the brain and spinal cord.2

A transvaginal ultrasound is helpful because it is typically more accurate than a traditional abdominal ultrasound. In a transvaginal ultrasound, a special kind of wand called a transducer is inserted into the vagina. It can then be placed near the ovaries.1,2

Sound waves given off by the transducer bounce off organs and create a picture of the organs that can show any growths or tumors that might be present. Ultrasounds are often the first imaging test done to see if a lump or mass is a fluid-filled cyst or a solid tumor.1,2

A CT (computed tomography) scan is an X-ray that constructs detailed cross-sections of your body. While CT scans are not very good at showing small tumors, they do show larger tumors. This is also a good test to see if the cancer has spread to other parts of the body.2

In a PET (positron emission tomography) scan, a person is given radioactive glucose, or sugar. Cancer cells are more likely to take in more glucose than noncancerous cells. A PET scan uses a special camera to create pictures of radioactive activity in the body. Cancerous areas show up differently with the radioactive glucose than noncancerous areas. This test is not as detailed as a CT scan but can show whether abnormal areas seen on a CT scan or ultrasound are likely to be cancerous or not.2

Blood tests

There are several blood tests that help diagnose ovarian cancer and rule out other conditions. This can include organ function tests or markers to give the doctor an idea of your overall health. Blood work for tumor markers may also be ordered.3

The blood test that looks for the cancer antigen (CA) 125 is often used. CA-125 is a protein that is produced on the surface of cells and released into the blood. CA-125 levels can be elevated from a variety of things, so this test is often used along with other diagnostic tests. The CA-125 test can be used to evaluate how effective treatment is. It can also provide some information about the prognosis or how the cancer is progressing.3

Other tumor marker blood tests that might be used include human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP), and/or lactate hydrogenase (LDH). If your doctor thinks your cancer might be a germ cell ovarian cancer, these tests might be ordered.2

If your doctor suspects that you have an ovarian stromal tumor, you might also have blood work to test your estrogen, testosterone, and inhibin (a hormone produced in the ovaries) levels.2

Genetic tests

A genetic test is a blood test that looks for changes or mutations in certain genes that can increase the risk of developing certain diseases or conditions. This includes conditions like ovarian cancer and breast cancer.

One out of every 4 women with ovarian cancer has a hereditary mutation. Getting genetic testing can help shape health screenings, treatment choices, and impact families and their knowledge of their larger health risks.4

Surgery and biopsy

In some cases, ovarian cancer requires surgery and a biopsy to confirm a diagnosis. This may include surgical removal of one or both ovaries, or oophorectomy. Your doctor may remove tissue from the abdomen through robotic laparoscopic (minimally invasive) surgery so it can be examined in a lab for signs of cancer.1

If cancer is found, it is then typically removed, and the cancer is staged. Staging cancer involves categorizing the cancer based on tumor size and whether it has spread anywhere.1

Things to consider

Getting an accurate diagnosis of ovarian cancer is important and often requires a variety of tests. If your doctor is not open to doing more than one kind of test to evaluate you for ovarian cancer despite your symptoms, consider getting a second opinion. Multiple tests provide as much information as possible to a doctor. This allows them to make accurate, definitive decisions that impact the course of treatment and prognosis.

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