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Ovarian cancer

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Diagnosing ovarian cancer

Diagnosis is the process of finding the cause of a health problem. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other reasons for a health problem before making a cancer diagnosis. Diagnostic tests for ovarian cancer are usually done when:

  • the symptoms of ovarian cancer are present
  • the doctor suspects ovarian cancer after talking with a woman about her health and doing a physical examination

Many of the same tests used to initially diagnose cancer are used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following.

Medical history and physical examination

The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past. The medical history of a woman’s family may also help the doctor to diagnose ovarian cancer.

In taking a medical history, the doctor will ask questions about:

  • a personal history of
    • breast cancer
    • Lynch syndrome (also called hereditary non-polyposis colorectal cancer, or HNPCC)
    • pregnancies
    • hormone replacement therapy
    • smoking
    • exposure to asbestos
    • surgery on reproductive organs (gynecologic tract)
  • a family history of
    • ovarian cancer
    • other cancers, such as breast, uterine and colon cancers
    • risk factors that may increase the risk of developing ovarian cancer
  • signs and symptoms that may suggest ovarian cancer

A physical examination allows the doctor to look for any signs of ovarian cancer. During a physical examination, the doctor may:

  • do a pelvic examination to check the uterus, vagina, ovaries, Fallopian tubes, bladder and rectum for any unusual changes
  • feel the abdomen for lumps, bloating or enlargement of organs (such as the liver)

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Transvaginal ultrasound

Ultrasound uses high-frequency sound waves to make images of structures in the body. With a transvaginal ultrasound, the sound waves are produced by an ultrasound wand that is placed in the vagina and aimed at the ovaries. Transvaginal ultrasound is used to:

  • find an ovarian tumour and see if it is a solid tumour or a fluid-filled cyst
  • see the shape and size of the ovary and how it looks inside
  • check for a buildup of fluid in the abdomen (ascites)

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Tumour marker tests

Tumour markers are substances – usually proteins – in the blood that may suggest the presence of ovarian cancer. Tumour marker tests are used to check a person’s response to cancer treatment, but they can also be used to diagnose some of the less common forms of ovarian cancer.

The tumour markers that may be measured are:

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Blood chemistry tests

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities. They are used to diagnose and stage ovarian cancer.

  • Some women with ovarian stromal tumours will have higher levels of certain hormones, such as estrogen, testosterone or inhibin.
  • Higher levels of lactate dehydrogenase (LDH) may indicate ovarian germ cell tumours or that cancer has spread to the liver.

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Computed tomography (CT) scan

A CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. It is used to:

  • assess the pelvis, abdomen and lymph nodes around the ovaries
  • see if cancer has spread to other organs or tissues
  • help the doctor biopsy an area of suspected metastasis

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Laparoscopy

During a laparoscopy, the doctor places a thin tube (laparoscope) into the abdominal cavity through a small cut (incision) in the abdomen. Surgical instruments can be passed through the laparoscope to remove small pieces of tissue. Laparoscopy is done to:

  • check for abnormal growths and remove samples of tissue from the ovaries and other abdominal organs
  • remove tumours or cysts that appear to be quite small on imaging tests
  • help confirm the stage of a cancer
  • plan surgery or other treatments

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Biopsy

During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample.

Biopsies for ovarian cancer are done during a laparotomy. The surgery is used to diagnose, stage and treat ovarian cancer, often all at the same time. The surgeon makes a large cut (incision) in the abdomen to examine the organs in the abdominal cavity. During this surgery, the surgeon removes tissue samples from different parts of the pelvis and abdomen. The entire tumour is usually removed during this surgery. The samples are sent to the lab to help stage the cancer (this is called surgical staging).

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Paracentesis

A paracentesis is a procedure in which a hollow needle or tube is inserted through the skin and into the abdominal cavity. This procedure is done to remove a buildup of fluid in the abdomen (ascites). The fluid is examined for cancer cells.

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Chest x-ray

An x-ray uses small doses of radiation to make an image of the body’s structures on film. It is used to look for signs of fluid around the lungs (pleural effusion) that could be caused by advanced ovarian cancer.

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Complete blood count

A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to:

  • provide information about a woman’s general health
  • check for anemiaanemiaA reduction in the number of healthy red blood cells. from long-term (chronic) bleeding, especially if the ovarian cancer has spread to the small intestine or large intestine (bowel)
  • provide a baseline to compare with future CBCs during and after treatment

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Barium enema

A barium enema may be done to see if the ovarian cancer has spread to the colon or to rule out colon cancer.

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Colonoscopy

A colonoscopy may be done to see if the ovarian cancer has spread to the colon or to rule out colon cancer.

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Positron emission tomography (PET) scan

A PET scan uses radioactive materials (radiopharmaceuticals) to detect changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-dimensional colour images of the area being scanned. It may be used to find ovarian cancer that has recurred or has spread to other organs or tissues.

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See a list of questions to ask your doctor about diagnostic tests.

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