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Ovarian Cancer Diagnosis

At MD Anderson, our experts use the most advanced and accurate equipment available for ovarian cancer diagnosis and determine with pinpoint accuracy if and where it has spread. They have extensive experience with all types of ovarian cancer, including rare ovarian cancers. The chances for successful ovarian cancer treatment are much higher if the cancer is caught early and diagnosed accurately. If ovarian cancer is diagnosed in the early stages, the chances for successful treatment are high.

Testing for Ovarian Cancer

If you have symptoms that may signal ovarian cancer, your doctor will examine you and ask you questions about your health and family medical history. One or more of the following tests for ovarian cancer may be used to find out if you have the disease and if it has spread. These tests also may be used to find out if treatment is working.

Pelvic Exam

The doctor inserts one or two gloved fingers into the vagina and presses on the lower abdomen with the other hand. Usually the doctor puts a finger in the vagina and rectum at the same time to feel deeper in the pelvis. A pelvic exam helps find out if there is a mass on either side of the uterus. This may be a sign of ovarian cancer.

Ovarian Cysts

In some other cases, a mass may be an ovarian cyst. Ovarian cysts are solid or fluid-filled pockets on the ovary and usually are not cancerous, although risk increases with age.

Blood Test for Ovarian Cancer

This blood test measures the level in your body of CA-125, a protein that is made by ovarian cancer cells. CA-125 is known as a tumor marker because its levels usually are higher in women with ovarian cancer. Testing CA-125 levels is most reliable when it is used to find cancer that has come back after treatment. Doctors look at how the levels of CA-125 have changed over time.

Measuring CA-125 levels also can be used:

To see if treatment is working
Predict if a treatment might be effective for ovarian and some other types of cancer

The CA-125 test alone cannot find ovarian cancer. A high level of CA-125 does not always mean you have ovarian cancer. Other conditions may raise the level of CA-125. Low levels of CA-125 do not mean you are cancer-free. Some types of ovarian cancer produce only low levels of CA-125 or none at all.

Ovarian Cancer Biopsy

The only way to find out for certain if a growth is ovarian cancer is for the doctor to remove cells from it and look at them under a microscope (biopsy). Tissue can be removed by:

Surgery
Laparoscopy
Fine needle aspiration (FNA)

Ovarian Cancer Imaging

CT or CAT (computed axial tomography) scans
MRI (magnetic resonance imaging) scans
PET (positron emission tomography) scans
Chest X-rays
Transvaginal ultrasound: A wand-shaped scanner is put into the vagina. It has a small ultrasound device on the end.

Genetic Testing for Ovarian Cancer

If you are at high risk for ovarian cancer because of personal or family history, your doctor may ask you to have more tests, including some that give information about your genes. These tests may help you make important decisions about cancer prevention for yourself and your children. There are benefits and risks with genetic testing, which you should discuss with your doctor. Blood tests can find out if you have a BRCA1 or BRCA2 gene, which can cause ovarian cancer as well as breast cancer. Others test for genes that play a part in Lynch syndrome, an inherited colon cancer syndrome.

Ovarian Cancer Staging

Staging is a way of determining how much disease is in the body and where it has spread. This information is important because it helps your doctor decide the best type of treatment for you and the outlook for your recovery (prognosis). Staging of ovarian cancer is done during surgery. It usually requires removing the uterus, ovaries and fallopian tubes, as well as the omentum (a layer of fatty tissue covering the stomach area) and lymph nodes close to the tumor.

Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.

Did You Know?

Aggressive ovarian cancer is part of MD Anderson's Moon Shots Program™: an ambitious effort to reduce cancer deaths through the rapid discovery and implementation of new treatments.

Ovarian Cancer Stages

(source: National Cancer Institute)

Stage 1 Ovarian Cancer

The cancer is limited to the ovary or ovaries.

Stage 1A: Cancer is in one ovary
Stage 1B: Cancer is in both ovaries
Stage 1C: Cancer is in one or both ovaries. It also is on the surface of the ovary or in abdominal fluid or a fluid-filled capsule has burst.

Stage 2 Ovarian Cancer

The cancer is in one or both ovaries. It has spread to other parts of the pelvis.

Stage 2A: The tumor has spread to the uterus, Fallopian tubes or both
Stage 2B: The tumor has spread to the bladder, rectum or colon
Stage 2C: The tumor has spread to any of the above. Also, it is on the surface of the ovary, a fluid-filled capsule has burst or cancer cells are in abdominal fluid.

Stage 3 Ovarian Cancer

The cancer is in one or both ovaries. It has spread to nearby lymph nodes or other abdominal organs, not including the liver.

Stage 3A: The cancer:
- Has spread to the lining of the abdomen
- Cannot be seen
- Has not spread to the lymph nodes
Stage 3B: The cancer:
- Has spread into the abdomen
- Is visible (less than 2 centimeters, about 3/4 of an inch)
- Has not spread to the lymph nodes
Stage 3C: The cancer:
- Has spread into the abdomen
- Deposits are larger than 2 centimeters
- Has spread to the lymph nodes

Stage 4 Ovarian Cancer

The cancer has spread to the lung, liver or other distant organs.

Recurrent Ovarian Cancer

The cancer has come back after it has been treated. It may appear in other parts of the body, but it is still ovarian cancer.