The following information outlines the necessary procedures to help diagnose ovarian cancer.
How does my doctor know I have ovarian cancer?
This information was provided by the Women’s Cancer Network. www.wcn.org
If you have any symptoms or if your doctor found a mass during a routine pelvic exam, he or she is likely to ask questions about these things.
Family history of cancer
Reproductive history, such as whether or not you’ve been pregnant
In addition to asking you questions, your doctor may also perform a physical exam. You may have a pelvic exam and other tests.
Pelvic Exam- This exam allows your doctor to feel for lumps and other problems. During a pelvic exam, you lie on your back on an examining table, with your feet in stirrups. Your doctor inserts 1 or 2 fingers of a gloved hand inside your vagina and uses the other hand to press on your lower abdomen to feel for lumps. Your doctor may also insert a finger in your rectum to feel for anything unusual.
Transvaginal Ultrasound- This test allows your doctor to see if a cyst or tumor is present. The doctor aims sound waves at your ovaries either by inserting a small probe into your vagina, called a transvaginal ultrasound. Or, the doctor may aim the sound waves at the surface of your abdomen. The pattern of the echoes makes a picture, called a sonogram, on a video screen. The echoes are different for healthy tissues, fluid-filled cysts, and tumors. Fluid-filled lumps are usually not cancerous. You don’t need sedation for this test.
CA-125 Blood Test – This blood test shows how much of a protein called CA-125 is in your blood. An elevated CA-125 indicates the presence of tumor cells. After a diagnosis of ovarian cancer, your doctor may use this blood test to see whether you are responding to treatment, or if the cancer has come back. This test is usually combined with ultrasound.
Biopsy- Unlike many types of cancer, a biopsy is rarely used to diagnose ovarian cancer before surgery. A diagnosis of ovarian cancer is usually confirmed at the time of surgery. At that time, the surgeon removes the tumor or tumors. In a lab, a pathologist examines the removed cells to confirm that cancer is present.
Tests that Help Evaluate Ovarian Cancer
Your doctor may request other tests to learn more about your type of cancer and its location. This will help determine the stageof the cancer so your doctor can help decide on the treatment that is likely to be most effective for you. Except for colonoscopy, all of these tests are imaging tests,which help your doctor see what’s happening inside your body. You may have one or more of these tests.
Abdominal Ultrasound – You may have this test after a trans-vaginal ultrasound. Its goal is to find the presence of ascites, which is a build-up of fluid in the abdominal cavity. Ascites may occur when cancer grows on the surface of organs in this area. For this test, the doctor places a special, small probe over your abdomen. The probe sends out sound waves which make echoes that are captured by a special computer. The computer transforms the echoes into a picture called a sonogram.
Computed Tomography (CT) Scan – These special X-rays are more sensitive than a typical X-ray. When you have ovarian cancer, these pictures help your doctor see if the tumors have spread to other organs in your abdomen or pelvis.
To have the test, you lie still on a table as it gradually slides through the center of the CT scanner. Then the scanner directs a continuous beam of X-rays at your pelvis for about 15 to 25 seconds. A computer uses the data from the X-rays to create many pictures of your pelvis, which can be used together to create a three-dimensional picture.
A CT scan is painless and noninvasive. You may be asked to hold your breath one or more times during the scan. In some cases, you may drink a contrast dye 4 to 6 hours before the scan. And you may not be able to eat anything in the time between drinking the contrast dye and the scan. The contrast dye will gradually pass through your system and exit through your bowel movements.
Lower GI Series- A lower GI series is a series of X-rays of the colon and rectum. It checks for tumors or abnormal growths. Your doctor will tell you how to prepare for this test. During the exam, a white, barium-containing solution is inserted into your rectum. This makes the colon and rectum and any potential tumors or abnormal areas easier to see on the X-ray.
Colonoscopy – Doctors use this test to find out if cancer came from the intestines. To prep for this test, you take laxatives to clean out your large intestine. Then, the doctor inserts a fiber-optic tube, called a colonoscope, into your rectum. The doctor passes the tube through your whole colon. The doctor uses this tube to see inside your colon. He or she can also take tissue samples of any suspicious looking places. Then, a pathologist examines them under a microscope to see if any are cancerous. This test is uncomfortable, so you are sedated, but awake. Because of the sedation, you will need someone to drive you home after the test.
Magnetic Resonance Imaging (MRI) – Doctors use MRIs to tell if cancer has spread outside of your ovary. MRIs make a very clear picture of your ovary. For this test, you lie still on a table as it passes through a tube-like scanner. The scanner directs a continuous beam of radiofrequency radiation at the area being examined. A computer uses the data from the radio waves to create a three-dimensional picture of the inside of your body. You may need more than one set of images. Each one may take 2 to 15 minutes, so the whole scan may take an hour or more. This test is painless and noninvasive. Ask for earplugs if they aren’t offered since there is a loud thumping noise during the scan.If you’re claustrophobic, you may take a sedative before having this test.
Surgery to remove samples of tissue for testing. If other tests suggest you may have ovarian cancer, your doctor may recommend surgery to confirm the diagnosis.
During surgery, a gynecologic oncologist makes an incision in your abdomen to explore your abdominal cavity and determine whether cancer is present. In some cases, the surgeon may use several small incisions and insert special surgical tools to perform minimally invasive surgery or robotic surgery.
The surgeon may collect samples of abdominal fluid and remove an ovary or other tissue for examination by a pathologist. If cancer is discovered, the surgeon may immediately begin surgery to remove as much of the cancer as possible.
CA 125 blood test.
CA 125 is a protein found on the surface of ovarian cancer cells and some healthy tissue. 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. For this reason, a CA 125 test isn’t usually used to diagnose or to screen for ovarian cancer, but it may be used after diagnosis to monitor how your treatment is progressing.
Staging ovarian cancer
Doctors use the results of your surgery to help determine the extent — or stage — of your cancer. Your doctor may also use information from imaging tests, such as computerized tomography (CT). Your cancer’s stage helps determine your prognosis and your treatment options.
Stages of ovarian cancer include:
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 beyond the pelvis or to the lymph nodes within the abdomen.
Stage IV. Ovarian cancer has spread to organs beyond the abdomen, such as the liver or the lung