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Ovarian cancer diagnosis often begins when a mass is felt on the ovaries during a routine physical exam or during an exam to determine the cause of persistent, abnormal symptoms. After a mass is felt, ultrasound or computer tomography (CT) images will be ordered and a blood test for the CA125 tumor marker will be run. Further imaging of the chest and colon may be ordered if metastasis of the ovarian cancer is suspected. If warranted, surgery will be performed to survey both the reproductive organs and abdominal cavity and remove the cancer.
Symptoms are typically the first sign of a medical problem and are often used in diagnosis. The symptoms of ovarian cancer are similar to several benign medical conditions and therefore do not often prompt a gynecological office visit. As a result, tumors are often found during routine gynecological exams. In some cases, several persistent symptoms, such as abdominal pressure, pelvic pain, loss of appetite, and bowel or bladder changes may illicit a doctor’s visit and warrant a pelvic exam.
During a gynecological exam, the doctor will palpate the reproductive organs. If a mass is felt or suspected, the next step in ovarian cancer diagnosis will be to image the ovaries. Ultrasound or CT images will be used to review the ovaries and search for signs of metastasized cancer throughout the entire abdominal cavity. If the cancer has metastasized, additional imaging, such as a chest x-ray, a barium enema x-ray, or a magnetic resonance imaging (MRI) may be ordered to determine the spread of the tumors.
Ovarian cancer cells, other types of tumor cells, and sometimes normal cells will have a protein tumor marker on their surfaces called CA125. This semi-specific protein can be used as an indicator of ovarian cancer and aid in ovarian cancer diagnosis. When CA125 is elevated in the blood it may suggest that ovarian cancer is present, but some benign conditions, such as pregnancy, endometriosis, and fibroid tumors can also produce an elevated CA125 value. The CA125 blood test is used as one small piece in ovarian cancer diagnosis. This test is also used to establish a baseline for monitoring the effectiveness of any future chemotherapy.
If a mass is observed on the ovaries or in the abdominal cavity, surgery will be ordered. Surgery for ovarian cancer diagnosis can be performed using laparoscopic surgery or as open laparotomy. During the surgical procedure, the ovaries, internal organs, diaphragm, walls of the abdomen, abdominal fat, and lymph nodes will be reviewed for any signs of cancer.
A small sample will be removed if cancer cells are suspected. In the operating room, the specimens will be flash-frozen, sectioned into extremely thin slices for review with a microscope, and examined by a pathologist. All identified cancer cells will be removed. The stage or spread of the ovarian cancer will be carefully recorded and used later to determine the type of treatment.