Diagnosis of Ovarian Cancer

Women with any of the symptoms suggestive of ovarian cancer should be evaluated by their health care provider. The first step in diagnosis is to have a thorough history and physical exam. The health care provider will evaluate the medical history, including risk factors for ovarian cancer, and perform a physical exam which may include a pelvic exam. Feeling the ovaries during a pelvic exam may help lead to a diagnosis, however, the ovaries are located deep within the pelvis and are often difficult to feel, particularly in early stages of disease. Occasionally, an ovarian mass may be felt on a routine physical exam prompting further diagnostic testing in a woman who otherwise does not have symptoms.

After the history and physical is complete several tools can help point to a diagnosis of, or decrease the concern for, ovarian cancer.

Ultrasound is one of the most useful tools available to evaluate the ovaries, however, it’s not the perfect tool in that it cannot be used to diagnose ovarian cancer; it can only suggest that ovarian cancer is a possibility based on the size and characteristics of the ovary. In addition, ultrasound can miss early stages of the disease.

CA 125 is a protein present in cancerous ovarian cells. The blood level of this protein can be raised in women with ovarian cancer, however, many women with ovarian cancer can have normal levels, and many women may have raised blood levels despite being healthy. Additionally, several other non cancer related conditions can cause a rise in the blood level of CA 125. CA 125 is often used in combination with ultrasound to evaluate women at risk for, or with symptoms suggestive of, ovarian cancer. Other similar proteins are currently being studied for use with CA 125 to improve the early detection of ovarian cancer.

Surgery is necessary for the absolute diagnosis of ovarian cancer as well as to determine the extent, or stage, of disease. It is also the first step of treatment. Women with diagnostic findings suggestive of ovarian cancer should be evaluated by a gynecologic oncologist, a physician who specializes in cancer of the female reproductive system, to pursue ovarian cancer surgery.