Ovarian cancer usually produces no symptoms until it is in an advanced stage. Very few women have it detected early on a routine pelvic exam or because it produced a symptom. Ovarian cancer may be detected incidentally during a routine physical exam or test.
You will be asked about your medical and family history. A pelvic exam will be done. A pelvic exam is a thorough, manual evaluation of the vagina, cervix, uterus, fallopian tubes, and ovaries. A Pap smear will also be done. This test removes a sample of cervical tissue for examination under a microscope. This may be done whether or not you are having symptoms.
If abnormalities are found during a physical and/or pelvic exam, the following tests may be done to identify the changes. Not all ovarian abnormalities are cancer. Tests to help distinguish noncancerous and potential cancerous changes include:
- Blood tests—Blood tests may identify markers or genetic mutations in the blood. For example, tumor markers (like CA-125) or specific blood proteins may be elevated in the presence of cancer. Tumor markers are also used to stage the cancer and evaluate if the treatments are working.
- Imaging tests (ultrasound, CT scan, and MRI scan)—A transvaginal ultrasound can often be performed in your doctor's office and gives satisfactory images of the pelvic organs. It involves the use of a portable machine and a probe, which is inserted into your vagina. CT and MRI scanning may only be available at hospitals and medical imaging centers.
- Colonoscopy or barium enema—Although intended mainly for intestinal diagnosis, these images sometimes help diagnose problems in the nearby female reproductive organs. You should not eat or drink on the day of the exam. Before the procedure, you will take a laxative or have an enema to empty your bowels. In the x-ray suite, after preliminary x-rays, you will receive an enema of barium. This allows your lower bowel to be visible on an x-ray.
- Biopsy—Suspicious masses in your ovaries may require a biopsy to determine if they are cancerous. For a biopsy, a sample of tissue is removed for examination under a microscope. Pieces of the mass can often be obtained with a long needle or taken through small incisions using a laparoscope—a thin, lighted telescope that looks inside your abdomen. In some cases, a surgeon may need to perform open surgery to reach the mass. The tissue sample is sent to the pathology lab to be examined for cancer cells.
If cancer is found, the prognosis and treatment depend on the location, size, and stage of the cancer, as well as your general health. Staging is a careful attempt to determine whether the cancer has spread and, if it has, what body parts are affected.
Additional tests to determine staging may include:
- Urine and blood tests
- Additional physical exams, including another pelvic exam in the operating room under anesthesia
- Images of other parts of the body, including lungs, bladder, kidneys, and lymph nodes
- Removal and microscopic examination of abdominal tissue
The following stages are used to classify cancer of the ovary:
- Stage I—cancer involves the ovary but has not spread
- Stage II—cancer has spread to nearby areas, but is still inside the pelvis
- Stage III—cancer has spread throughout the abdomen
- Stage IV—cancer has spread to other parts of the body
Beyond staging, a pathologist looks at the tumor through a microscope. The appearance of the cancer cells gives a good idea of how aggressive the cancer is. Grading the cancer adds to the staging information to help determine how best to treat you.