ovarian cancer : How Is Ovarian Cancer Diagnosed?

Ovarian cancer may cause several signs and symptoms. However, most of these may also be caused by benign (non-cancerous) diseases and by cancers of other organs. The most common symptom is back pain, followed by fatigue, bloating, constipation, abdominal pain and urinary urgency. These symptoms tend to occur very frequently and become more severe with time. Most women with ovarian cancer have at least 2 of these symptoms.

Others symptoms, which tend to occur later in the course of the disease, are prolonged swelling of the abdomen, abdominal pain and cramping, a feeling of pelvic pressure, vaginal bleeding, and leg pain.

If there is reason to suspect you may have ovarian cancer, your doctor will use one or more methods to be absolutely certain that the disease is present and to determine the stage of the cancer.

Consultation With a Specialist

If your pelvic examination or other tests suggest that you may have ovarian cancer, you will need a doctor or surgeon who specializes in treating women with this type of cancer. A gynecologic oncologist is an obstetrician/gynecologist who is specially trained in treating cancers of the female reproductive system.

Imaging Studies

Imaging methods such as computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and ultrasound studies can confirm whether a pelvic mass is present. Although these studies cannot confirm that the mass is a cancer, they are useful if your doctor is looking for spread of ovarian cancer to other tissues and organs.

Ultrasound: Ultrasound (ultrasonography) is the use of sound waves to create an image on a video screen. Sound waves are released from a small probe placed in the woman's vagina or on the surface of her abdomen. The sound waves create echoes as they enter the ovaries and other organs. The same probe detects the echoes that bounce back, and a computer translates the pattern of echoes into a picture. Because ovarian tumors and normal ovarian tissue often reflect sound waves differently, this test may be used to find tumors and determine whether a mass is solid or a fluid-filled cyst.

Computed tomography (CT): The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body. The machine will take pictures of multiple slices of the part of your body that is being studied.

CT scans are useful in showing how large the tumor is, what other organs it may be invading, whether lymph nodes are enlarged and whether the kidneys or bladder are affected.

This test can help tell if your cancer has spread into your liver or other organs. Often after the first set of pictures is taken you will receive an intravenous injection of a "dye" or contrast agent that helps better outline structures in your body. A second set of pictures is then taken.

CT scans can also be used to precisely guide a biopsy needle into a suspected metastasis. For this procedure, called a CT-guided needle biopsy, the patient remains on the CT scanning table, while a radiologist advances a biopsy needle toward the location of the mass. CT scans are repeated until the doctors are confident that the needle is within the mass. A fine needle biopsy sample (tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of tissue about ½ inch long and less than 1/8 inch in diameter) is removed and examined under a microscope.

CT scans take longer than regular x-rays and you need to lie still on a table while they are being done. But just like other computerized devices, they are getting faster and the most modern ones only take seconds..

You will need to have an IV (intravenous) line through which the contrast "dye" is injected. The injection can also cause some flushing. Some people are allergic and get hives or, rarely, more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays. You may be asked to drink 1 to 2 pints of a solution of contrast material.

Barium enema x-ray: This is a test to see whether the cancer has invaded the colon (large intestine) or rectum (it is also used to look for colorectal cancer). After taking laxatives the day before, the radiology technician puts barium sulfate, a chalky substance, into the rectum and colon. Because barium is impermeable (impossible for x-rays to go through) to x-rays, it outlines the colon and rectum on x-rays of the abdomen.

Colonoscopy: A colonoscopy is also done after the large intestine has been cleaned with laxatives. A doctor inserts a fiberoptic tube into the rectum and passes it through the entire colon. This allows the doctor to see the inside and detect any cancer. It is also used to look for colorectal cancer. Because this is uncomfortable, the patient will be sedated.

Magnetic resonance imaging (MRI): MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. Not only does this produce cross sectional slices of the body like a CT scanner, it can also produce slices that are parallel with the length of the body. A contrast material might be injected just as with CT scans, but this is done less often. MRI scans are not used often to look for ovarian cancer.

MRI scans are particularly helpful to examine the brain and spinal cord. MRI scans take longer than CT scans, – often up to 30 minutes or more. Also, you have to be placed inside a tube, which is confining and can upset people with claustrophobia (fear of enclosed spaces). The machine also makes a thumping noise that you may find disturbing. Some places will provide headphones with music to block the sound.

Chest x-ray: This procedure may be done to determine whether ovarian cancer has spread (metastasized) to the lungs. This spread may cause one or more tumors in the lungs and often causes fluid to collect around the lungs. This fluid, called a pleural effusion, can be seen with chest x-rays.

Positron emission tomography: Better known as a PET scan, this test uses radioactive glucose to look for the cancer. Cancers use glucose (sugar) at a higher rate than normal tissues. This means that the radioactivity will tend to concentrate in the cancer. In some instances this test has proved useful in finding ovarian cancer that has spread. It is even more valuable when combined with a CT scan (PET/CT scan).

Other Tests

Laparoscopy: This procedure uses a thin, lighted tube through which a doctor can look at the ovaries and other pelvic organs and tissue in the area around the bile duct. The tube is inserted through a small incision (cut) in the lower abdomen and sends the images of the pelvis or abdomen to a video monitor. Laparoscopy provides a view of organs that can help in planning surgery or other treatments and can help doctors confirm the stage (how far the tumor has spread) of the cancer. Also, doctors can manipulate small instruments through the laparascopic incision(s) to remove small tissue samples to examine under the microscope.

Colonoscopy: A colonoscopy is also done after the large intestine has been cleaned with laxatives. A doctor inserts a fiberoptic tube into the rectum and passes it through the entire colon. The images are sent to a video monitor. This allows the doctor to see the inside and detect any cancer. It is also used to look for colorectal cancer. Because this is uncomfortable, the patient will be sedated.

Tissue sampling:The only way to determine for certain if a growth in the pelvic region is cancer is to remove a sample of the growth from the suspicious area and examine it under a microscope. This procedure is called a biopsy. It can be done during the laparoscopy procedure. Or it can be done with a needle placed directly into the tumor through the abdomen. The skin of the abdomen will be numbed with local anesthetic. Usually the needle will be guided by either ultrasound or CT scanning. This method might be used if the patient cannot have surgery because of advanced cancer or some other serious medical condition. Often, a biopsy is done at the time of surgery.

In patients with ascites (collection of fluid inside the abdomen), samples of fluid can also be used to diagnose the cancer. In this procedure, the skin of the abdomen is numbed and a needle attached to a syringe is passed through the abdomen into the cavity. The fluid is sucked up into the syringe.

In all these procedures, the tissue obtained is sent to the pathology laboratory. There it is examined under the microscope by a pathologist, a doctor skilled in diagnosing cancer.

Blood tests: Your doctor will order blood counts to make sure you have enough red blood cells, white blood cells and platelets (cells that help stop bleeding). There will also be tests to measure your kidney and liver function as well as your general health status. Finally the doctor will order a CA-125 test. If the test is elevated, consultation with a gynecologic oncologist is recommended.

Copyright 2006 © American Cancer Society, Inc.