|How Is Ovarian Cancer Diagnosed?
A U.S. national survey on ovarian cancer found that up to 95 percent of women reported symptoms of ovarian cancer before their diagnosis. In particular they reported bloating, abdominal pain, urinary problems and feeling full soon after eating. As there is no screening process for ovarian cancer, very often it is only discovered in advanced stages. The diagnostic process can take several trips to the doctor and hospital so it can be several weeks before patients receive their final results. The process will include a full medical history and physical examination. A pap test, blood tests, biopsy and imaging techniques such as X-ray and ultrasound will give a clearer indication. Many women find the uncertainty of this testing and waiting period stressful. However, a complete and accurate picture of the disease is crucial for determining the correct ovarian cancer treatment.
Consultation With A Gynecologist
Most women will report their symptoms to their doctor who will carry out a full pelvic examination. If there are any irregularities the woman will be referred to a gynecologic oncologist who specializes in cancers of the female reproductive system.
The first thing the gynecologist will do is to take a full medical history. This should cover the following areas:
Family History: If any close member of the family ever had ovarian cancer.
Diet: Your daily eating habits and a breakdown of your food’s fat and fiber content as well as any vitamin or nutritional supplements you take.
Bladder Habits: How often you urinate, what color is the urine and have you noticed any changes in your bladder habits.
Bowel Changes: How often do you have a bowel movement, have there been any recent changes, do you suffer regular bouts of constipation or diarrhea.
Menstruation History: When did you have your first period (menarche), when, if they have, did they stop (menopause), how regular were/are your periods, do/did you suffer menstrual cramps, have there been any changes in your periods (e.g. missed periods or irregular periods).
Pregnancies: How many pregnancies have you had, how many live births, have you had any abortions, did/do you have any fertility problems.
The gynecologist will also carry out physical examination including a full pelvic exam and a Pap smear test. She will be looking for any tumors or lumps in the pelvic region and organs. The Pap test cannot show ovarian cancer but it can rule out other possible causes such as cervical cancer, vaginal cancer and vulva cancer. She may also recommend laxative supplements or an enema to empty the colon so that she can check the rectum area. If she discovers a mass, a benign tumor will feel smooth; fluid filled and can easily be moved. A cancerous tumor will not be moveable and will feel solid with an irregular shape. A clinician who suspects ovarian cancer must first rule out other possible causes such as ovarian cysts, endometriosis and gastrointestinal disease or bowel disorders.
A blood and urine test will test the body’s functions, in particular the liver and kidneys. Depending on the type of ovarian cancer suspected, levels of the tumor marker CA-125 may also be tested. High levels (above 35 U/ml) of this biomarker are present in 80 percent of women with epithelial ovarian tumors. However noncancerous conditions such as uterine fibroids and endometriosis can also cause elevated levels. Recently scientists discovered another specific marker for ovarian cancer called HE4; labs may also check for this. Some germ cell cancers can cause elevated levels of hCG and AFP (alpha-fetoprotein) and/or lactate dehydrogenase (LDH). Some stromal tumors can cause levels of a substance called Inhibin to increase in the bloodstream. All of these may be checked.
After this work-up in the doctor’s office, one or more imaging tests may be recommended and carried out at a nearby hospital.
Will I Survive? See Ovarian cancer survival rates
A pelvic ultrasound allows for a detailed imaging of the ovaries and for the detection of any changes which can indicate cancer. It is also commonly used to check ovarian cysts for signs of malignancy. An ultrasound, also called a ultrasonography, uses sound waves to create internal images of the body and sends them back to a video screen. If a mass is discovered the ultrasound can help determine if it is fluid filled or solid. A probe will be placed over the woman's abdomen and/or internally through the vagina (transvaginal ultrasound). An ultrasound might also be used to rule out the possibility of pregnancy.
Computed Tomography (CT) Scan
This procedure takes X-ray cross sectional images of the body. It may be used to define the size and location of a tumor. It can also help to check for signs of cancer spreading (metastasis) to other parts of the body such as the lungs or liver. It may also be used to guide a needle for biopsy (CT guided needle biopsy).
Barium Enema X-Ray
This test is taken to rule out tumors in the lower (sigmoid) colon or rectum. The patient is given laxatives to take the day before to clear their colon. On the day of the test the technician places a chalky substance called barium sulfate into the rectum and colon. Because the substance cannot be penetrated by X-rays it outlines the colon and rectum on the X-ray images. It is rarely performed these days for ovarian cancer. A colonoscopy is more likely to be performed.
A mammogram test may be performed to rule out breast cancer (see our breast cancer guide).
Magnetic Resonance Imaging (MRI) Scan
An MRI scan uses X-rays and strong magnets to produce detailed pictures of the body. It produces cross sectional images like the CT scan, but also vertical images. An MRI is unlikely to be used unless metastasis is suspected. A PET (Positron emission tomography) scan is another alternative for checking for metastasis. However it is expensive and most insurance companies will not cover the cost.
This will check for fluid (called pleural effusion) around the lungs which suggests cancer has metastasized.
This procedure is used to assess the internal organs with a thin lighted tube called a laparoscope which has an optic camera at the end. The tube is inserted through an incision made in the lower abdomen and images are then relayed to a video monitor. Laparoscopy gives a surgeon a good view of the tumor which allows them to put an optimal treatment plan in place. It also helps to confirm the stage of the cancer (see ovarian cancer stages). Doctors can sometime use the laparoscope with other small instruments to perform a biopsy.
Colonoscopy involves examining the inside of the colon and rectum with a lighted tube and camera. The tube is passed through the anus and allows for a visual diagnosis as well as biopsy of any suspicious areas. While a colonoscopy examines the entire colon, a sigmoidoscopy examines the last section near the anus which may be sufficient. Colonoscopy is more commonly performed for colorectal cancer.
No matter which tests are performed, a cancer diagnosis cannot be given without a biopsy. This involves removing a sample of cells from the suspicious tissue and examining it under a microscope. With ovarian cancer, the biopsy is only usually performed once the tumor has been removed by surgery. However, it can be done during a laparoscopy or by injecting a needle directly into the tumor through the abdomen. Usually the needle will need to be guided by a CT scan or ultrasound. A needle biopsy is usually only considered if the patient is unable for health reasons to undergo surgery.
Sample cells taken from biopsy are then sent to a pathologist for testing. This specialist doctor will be able to give a final diagnosis and furthermore determine the staging.
If symptoms return after previous treatment, this is known as a recurrence. To read more: ovarian cancer recurrence.