Diagnosis of ovarian cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing cancer often means first ruling out other health conditions that have similar symptoms. It can be a very worrying time for you and your loved ones. Sometimes this process is quick. Sometimes it can feel long and frustrating. But it's important for doctors to get all the information they need before making a diagnosis of cancer.

Diagnosing cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and will do physical and pelvic exams. Based on this information, your doctor may refer you to a specialist or order tests to check for cancer or other health problems. Many of the tests that are used to diagnose cancer are also used to find out the stage (how far the cancer has spread).

The following tests are usually used to rule out or diagnose ovarian cancer. They may also be used to diagnose fallopian tube and primary peritoneal cancers, which are very similar to ovarian cancer. These cancers start in the same type of tissue as most ovarian cancers and are staged and treated the same way. But they are much rarer than ovarian cancer.

Your health history is a record of your symptoms and risks and all the medical events and problems you have had in the past.

Your doctor will ask questions about your history of:

• symptoms that suggest ovarian, fallopian tube or primary peritoneal cancer
• breast cancer
• Lynch syndrome (also called hereditary non-polyposis colorectal cancer, or HNPCC)
• pregnancies
• hormone replacement therapy
• smoking tobacco
• exposure to asbestos

Your doctor may also ask about a family history of:

• ovarian, fallopian tube or primary peritoneal cancer
• Lynch syndrome
• infertility
• risks for ovarian, fallopian tube and primary peritoneal cancer
• other cancers, such as breast, uterine and colorectal cancers

A physical exam allows your doctor to look for signs of ovarian, fallopian tube or primary peritoneal cancer. During a physical exam, your doctor may:

• do a pelvic exam 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 or spleen

Find out more about a physical exam.

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 your general health, check for anemia from long-term vaginal bleeding and to provide a baseline to compare with future CBCs during and after treatment.

Find out more about a complete blood count (CBC).

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are working and can help find problems.

Blood chemistry tests may be used to help diagnose ovarian cancer. Certain enzymes and hormones may be higher in people with germ cell ovarian cancer and stromal cell ovarian cancer. Your doctor may test for the following:

• lactate dehydrogenase (LDH)
• alpha-fetoprotein (AFP)
• beta-human chorionic gonadotropin (beta-hCG)
• hormones such as estrogen and testosterone

Find out more about blood chemistry tests.

Tumour markers are substances found in the blood, tissues or fluids removed from the body. They may be made by cancer cells or by the body in response to the cancer.

An abnormal amount of a tumour marker may mean that a person has cancer, but they can also be made by other health conditions. Tumour marker tests are best used to monitor how treatment is working. Higher levels of a tumour marker may mean that the cancer has come back (recurred).

Certain tumour markers will be higher for different types of cancer. The following tumour markers may be tested to help diagnose ovarian, fallopian tube or primary peritoneal cancer.

Find about more about tumour marker tests.

Biopsies for ovarian, fallopian tube or primary peritoneal cancers are often done during surgical staging. Surgical staging can help diagnose, determine the spread of, and treat these cancers, often all at the same time.

During surgical staging, the surgeon makes a large cut (incision) in the abdomen to examine all organs in the abdominal cavity. They will remove as much of the tumour as possible. They'll also do a biopsy to remove tissue samples from different parts of the pelvis and abdomen to check if the cancer has spread to those areas.

These samples are sent to the lab where they are examined under a microscope. A report from the pathologist will confirm whether cancer cells are found in the samples, what type of cancer it might be and how far it has spread.

Find out more about biopsies.

An x-ray uses small doses of radiation to make an image of parts of the body on film. It's used to look for signs of fluid around the lungs (called pleural effusion) that could be caused by cancer that has spread to the lungs.

Find out more about x-rays.

An ultrasound uses high-frequency sound waves to make images of parts of the body. A pelvic or transvaginal ultrasound may be done to look for ovarian, fallopian tube or primary peritoneal cancer. With the transvaginal ultrasound, the ultrasound wand or probe is placed into the vagina, instead of on the surface of the abdomen, and aimed at the ovaries. Ultrasounds are used to:

• find an ovarian tumour and see if it's a solid tumour or a fluid-filled cyst
• see the shape and size of the ovary and how it looks inside
• look for abnormalities in other organs in the pelvis
• check for a buildup of fluid in the abdomen (called ascites)

Find out more about ultrasounds.

A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to:

• look for cancer in the pelvis, abdomen and lymph nodes around the ovaries
• see if cancer has spread to other organs or tissues
• guide a needle when doing a biopsy of an area that your doctor thinks cancer may have spread to

Find out more about CT scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures. An MRI is sometimes used to see if cancer has spread to the brain or spinal cord.

Find out more about MRIs.

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3D colour images of the area being scanned.

A PET scan may be used to find cancer that has come back or has spread to other organs or tissues.

Find out more about PET scans.

During a laparoscopy, the doctor makes a small cut (incision) in the abdomen and places a thin tube with a camera (called a laparoscope) into the abdominal cavity. Video images from the laparoscope are displayed on a screen. Surgical instruments can be passed through other small incisions to remove small pieces of tissue.

A laparoscopy may be done to:

• check for abnormal growths and remove samples of tissue from the ovaries and other organs in the abdomen
• remove small tumours or cysts
• help confirm the stage of a cancer
• plan further surgeries or other treatments

Find out more about a laparoscopy.

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 ascites, which is then examined for cancer cells.

Find out more about a paracentesis.

A colonoscopy may be done to see if ovarian, fallopian tube or primary peritoneal cancer has spread to the colon or to rule out a cancer that has started in the colon (called primary colon cancer).

Find out more about a colonoscopy.

To make the decisions that are right for you, ask your healthcare team questions about diagnosis.