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How Do Doctors Diagnose Ovarian Cancer?

Reviewed by Brunilda Nazario, MD on April 30, 2021

If you or your doctor is concerned that you might have ovarian cancer, there is no single test that will tell you for sure. Instead, it’s a process that will probably start with a pelvic exam.

Your doctor will:

  • Check the outer part of your genitals
  • Put two gloved fingers into your vagina and then press on your abdomen with the other hand (This helps your doctor check the size of your uterus and ovaries, as well as their position and shape.)
  • Put a device called a speculum into your vagina to look for anything that’s not normal

You may also get a rectovaginal exam. Your doctor inserts one finger into your rectum and another finger into your vagina at the same time to better feel the pelvic organs and check for any swelling.

Imaging Tests

A physical exam can only reveal so much. Your doctor may want to use imaging tests to get a clearer picture of your ovaries.

One such test in a transvaginal ultrasound. During the procedure, the doctor inserts a probe (also called a transducer) into your vagina. The probe bounces soundwaves off the structures of your body, and those waves make echoes, which in turn form a picture on a computer screen.

Another imaging test is a CT scan, which stands for "computed tomography." In a CT scan, an X-ray beam rotates around your body and takes images from various angles. A computer puts together all that information to produce a detailed look at that section of your body.

Blood Tests

There is no single blood test that shows whether you have ovarian cancer.

The main one that you may get is called the CA-125 test. It looks for a protein linked to ovarian cancer cells. But it’s not enough to make a diagnosis.

Some rarer types of ovarian cancer raise levels of other substances in the blood. Your doctor may order tests to look for higher levels of one or all of these:

Another type of ovarian tumor can raise the amount of estrogen and testosterone in your blood, and also a substance called inhibin. You may have a blood test to check these levels.

Two tests can help your doctor determine the risk of ovarian cancer if you have a mass in your pelvis that may require a referral for surgery. OVA1 measures five proteins in your blood, and computer software uses them to set a risk score. It does not screen for ovarian cancer and should not be used alone to determine the risks of this cancer. It has different cutoff levels depending on whether you’ve gone through menopause. The Risk of Ovarian Malignancy Algorithm (ROMA) also looks at menopause status as well as the proteins CA-125 and HE4 to predict whether a tumor is likely to be cancer.

Biopsy

The only way to know for sure whether you have ovarian cancer is with a biopsy. It’s usually done by a doctor called a gynecologic oncologist. It usually involves surgery to take out the area where cancer is suspected, after which it is sent to a lab for testing. A specialist called a pathologist will look at the tissue under a microscope and test it to find out if it’s cancer.

If you have ovarian cancer, you may have more tests, such an MRI or PET scan. They’ll help your doctor learn how advanced your cancer is so that you both can decide on your treatment plan, which may involve other surgeries, too.

Genetic Tests

If you knew that you were at high risk of ovarian cancer, you may have had tests to look for changes in certain genes. Similar testing on a tumor itself can tell your doctor more about it. Then, they’ll have a better idea of what treatments to use against the cancer.

WebMD Medical Reference

Sources

SOURCES:

Ovarian Cancer Research Fund Alliance: "Symptoms and Detection."

National Ovarian Cancer Coalition: "What are the Signs & Symptoms of Ovarian Cancer?"

Mayo Clinic: "Diseases and Conditions – Ovarian cancer."

National Ovarian Cancer Coalition: "How Am I Diagnosed with Ovarian Cancer?"

National Cancer Institute: "Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Screening."

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins: "About Ovarian Cancer."

American Cancer Society: "How Is Ovarian Cancer Diagnosed?"

Dana Farber Cancer Institute: "Susan F. Smith Center for Women’s Cancers – Ovarian Cancer."

Fox Chase Cancer Center: “Ovarian Cancer: What is OVA1 Test?”

University of Iowa Department of Pathology: “ROMA (Risk of Ovarian Malignancy Algorithm).”

Annals of Translational Medicine: “Current practices on genetic testing in ovarian cancer.”

National Comprehensive Cancer Network: “Ovarian cancer.”

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