Your doctor will ask about your symptoms, and medical and family history. Your abdominal and pelvic regions will be thoroughly examined. This will include a pelvic exam. A pelvic exam is a thorough, manual evaluation of the vagina, cervix, uterus, fallopian tubes, and ovaries. A Pap smear will also be done to remove a sample of cervical tissue. The sample will be examined under a microscope to look for any abnormalities. Your doctor may suspect ovarian cancer based on your symptoms, but will look for other possible causes. If ovarian cancer is suspected, you will be referred to a doctor who specializes in gynecologic cancers.
Suspicion of Ovarian Cancer
If you have symptoms, your doctor may conduct certain tests to identify abnormalities. These may include:
- Blood tests—Certain substances are released into the blood when a tumor develops. These tumor markers, such as CA-125 or other specific blood proteins, may be elevated in the presence of cancer. Tumor markers are also used in cancer staging and evaluating treatments to see if they are working.
- Imaging tests—To assess internal structures for the presence and location of tumors. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may include:
Diagnosis of Ovarian Cancer
Diagnosis of ovarian cancer is confirmed with a biopsy. A biopsy is the removal of suspicious tissue for examination under a microscope. Since ovarian cancer is usually found in advanced stages, there are different methods for determining if cancer is present. These may include:
- Surgical removal of the entire tumor—This is the most common method.
Needle aspiration—If surgery is not an option, your doctor may try an alternate method, though this is rarely done. A needle guided by imaging scans is inserted through the abdominal wall to:
- Take a piece of suspicious tissue
- Take fluid samples from the abdominal cavity—paracentesis
Staging of Ovarian Cancer
If ovarian cancer is confirmed, results from completed tests and new tests will help determine the stage of cancer. Staging is used to determine characteristics of the tumor that will help develop the prognosis and treatment plan. Factors that play a role in staging include where the tumor is found, how far the original tumor has spread, whether lymph nodes are involved, if cancer has spread to other tissue, and microscopic cellular details.
Surgical staging is done with an exploratory laparotomy. An incision is made in the abdominal wall to gain access to the abdominal and pelvic cavities. The areas can be examined for the presence of tumors. For ovarian cancer, this may include surgical removal of tumors, tissue, or organs in advance of other staging tests.
Tests that may help determine ovarian cancer stage:
- Blood tests to look for abnormal numbers of certain blood cells, proteins, indications of cancer, and abnormal cells. The tests may also show changes in kidney or liver function.
- Imaging tests—To help determine how deep the tumor has moved into the layers of the pelvis, abdomen, or beyond the primary site. They may also help to determine if there are any metastatic growths in other areas of the body. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may include:
- Other tests may include:
- Colonoscopy—A thin, lighted tube with a tiny camera attached is inserted into the rectum and passed into the colon. The inside of the colon and rectum are examined for the presence of polyps or cancer. Any suspicious tissue can be removed during this procedure.
- Peritoneal wash—The peritoneum, a fluid-filled membrane that surrounds and supports the abdominal cavity, is washed with a saline solution. Cells in the wash are collected and examined for the presence of cancer.
- Tissue evaluation—Cancer tissue from the biopsy will be closely examined to look for characteristics that can help with prognosis and treatment selection.
Ovarian cancer is staged from I-IV:
Ovarian cancer is staged from I-IV:
- Stage IA—Cancer is in ONE ovary OR fallopian tube.
- Stage IB—Cancer is in BOTH ovaries OR fallopian tubes.
Stage IC—Cancer is found in ONE or BOTH ovaries OR fallopian tubes WITH:
- Cancer on the outside of ONE or BOTH ovaries OR fallopian tubes.
- The capsule surround the ovary has ruptured. This can occur before or during surgery.
- Cancer cells are in the fluid of the peritoneum and/or peritoneal cavity.
Stage II—Cancer is in ONE or BOTH ovaries OR fallopian tubes and has spread to nearby pelvic or abdominal organs.
- Stage IIA—Cancer has spread FROM the ovaries AND/OR fallopian tubes TO the uterus.
- Stage IIB—Cancer has spread TO nearby pelvic organs, including the bladder, rectum, or colon.
Stage III—Cancer is in ONE or BOTH ovaries OR fallopian tubes WITH spread from the pelvis TO the abdomen AND/OR lymph nodes.
- Stage IIIA—Cancer is in the lymph nodes in and around the back of the abdomen, but outside of the peritoneum OR cancer cells are found ON the peritoneal layer OR IN the pelvic lymph nodes.
- Stage IIIB—Cancer is outside of the pelvis and in the peritoneum. Tumor is 2 centimeters (cm) or less. Cancer may be in the lymph nodes in and around the back of the abdomen, but outside of the peritoneum.
- Stage IIIC—Cancer is outside of the pelvis and in the peritoneum. Tumor is more than 2 centimeters (cm). Cancer may be in the lymph nodes in and around the back of the abdomen, or ON the surface of abdominal organs like the liver or spleen.
- Stage IVA—Cancer is contained to the pelvis and abdomen, but cancer cells are in the pleural fluid that surround the lungs.
- Stage IVB—Cancer has spread to other parts of the body. The most common sites for metastatic ovarian cancer are the lymph nodes in other parts of the body, lungs, liver, and bones.
To help streamline treatment planning, stage I cancer is considered early stage cancer, while stages II-IV are considered advanced stage cancer.