Ovarian Cancer Diagnosis

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If a woman feels she is at risk for ovarian cancer, the next step is going to her doctor to ask about a screening. Because getting an ovarian cancer diagnosis as early as possible is key to treatment and a quick recovery, the sooner she is tested, the better.

But how is ovarian cancer diagnosed? For most women, the diagnosis is done in stage 2, when the disease has progressed enough that symptoms are severe enough to seek medical attention. From there, a team of doctors will move her through a series of screenings and tests to determine if she has ovarian cancer.

There is no one right way to test for ovarian cancer. It is known for being one of the hardest cancers to detect. Even now, doctors are still fighting to find a screening that works.

But there is a group of screenings that can help a doctor. Be advised, however, that most doctors — and the medical community — suggest that women do not get routinely screened for ovarian cancer. The screenings are not always accurate and it has caused vigorous debate within this cancer community about how best to test for ovarian cancer.

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Screening Debate

There is no currently efficient method on how to test for ovarian cancer. Because all the tests are unreliable in accurately detecting ovarian cancer, women are often left undiagnosed until the advanced stages of this cancer.

There was real hope for the CA-125 blood test, which will be discussed below, and its efficacy in accurately diagnosing women with ovarian cancer. However, it has been proven that alone, it is not reliable. The test is known to cause false-positives, making women who don’t have ovarian cancer go through the entire process, only to find out they test negative for ovarian cancer.

But for women who are at high risk, these screenings are their best hope of receiving an early diagnosis. While the search for an accurate blood test for ovarian cancer continues, the screenings below are the only way to catch this cancer early. They should not be discounted.

These screenings are in chronological order. It will help women understand the screening process from start to finish. It will also serve as a guide to learning how each part of the screening process informs the rest to create a full diagnosis.

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Screenings

The ovarian cancer screening process can be long. For a lot of women who go through it, the process can stop at any step if another diagnosis is found. It is uncommon for most women to go through the entire process. For those that finish the screening process, a cancer diagnosis is likely.

Pelvic Exams

Ovarian cancer screenings almost always begin at an annual gynecological exam. Because the ovaries and reproductive system live inside a woman, it is harder for women to detect any abnormalities on their own.

A pelvic exam is a normal part of the visit. This is when the doctor physically inserts their fingers into the anus and the vaginal cavity to check for any unusual changes. Swelling, tenderness or hard lumps would be considered unusual changes, and may prompt the doctor to order a transvaginal ultrasound.

Please note that the Pap test, a test that often accompanies a pelvic exam, does not detect ovarian cancer. It is used to detect changes in the cervix and to test for cervical cancer.

Transvaginal Ultrasound

A transvaginal ultrasound is a test that is used to create a picture of a woman’s ovaries. The test is done by using an ultrasound wand that is inserted into the vagina. It maps out a woman’s ovaries along with any cysts, tumors, or other abnormalities.

It is a separate test that is normally conducted at a later date. It is most often done at a separate health facility, where the woman’s test is overseen by a specialist.

Many women who undergo a transvaginal ultrasound may find they have a tumor. Most tumors in the ovaries are benign, but any abnormal findings will prompt a doctor to order more tests to ensure the safety of their patient.

CA-125 Blood Test

This is a blood test for ovarian cancer and is generally only administered if a woman is at high risk for ovarian cancer. Because of the unreliable nature of the test, it may be accompanied by other blood tests.

The CA-125 blood test measures CA-125, a protein found in ovarian cancer cells. It is thought to determine if the level of the protein has increased in a woman’s bloodstream. If it has, it may be an indicator of ovarian cancer.

Other blood tests that have tumor markers, such as OVA-1 and HE4, may also be ordered to give a doctor a better understanding of what the tumor may in fact be. Many tumors that reside in a woman’s reproductive system are benign. Others are metastatic in nature, and that’s why these blood tests are important.

Risk of Ovarian Cancer Algorithm and CA-125

The question of how to test for ovarian cancer has long been unanswered, with the CA-125 blood test proving ineffectual in many cases. But a study by the scientists at the University College of London may be turning the tide on this view.

The ROCA, or the Risk of Ovarian Cancer Algorithm, is a new screening procedure that has just concluded a 14-year study. 200,000 women from all over the United Kingdom were recruited to test this procedure, showing promising, albeit controversial, results.

The ROCA uses the CA-125 blood test and a transvaginal ultrasound together to detect forming ovarian tumors. The study, which has yet to be verified by the medical community as a whole, showed that it was more effective at detecting stage 1 ovarian cancer than any other test alone.

However, the ROCA has detractors. The procedure failed to detect women who already had developed ovarian cysts and tumors. This has left the medical community to hold off on recommending the procedure to anyone.

This is an ongoing procedure debate, but it is hoped that the study will save more lives. As of this writing, however, the procedure has not been offered to women as an option.

X-Rays and CT Scans

X-Rays and CT scans are generally done at the same time. They work much like the transvaginal ultrasound but are far more precise in their depiction of a woman’s ovaries.

An x-ray creates a picture of the inside of a woman’s body, using a small amount of radiation to detect tumors and other masses. It gives doctors a better look at what is going on inside of a woman’s body, and gives them a better idea of what the tumor might be and it’s exact location.

The CT scan is a three-dimensional picture, created with the use of an x-ray machine. Instead of just one view, as with an x-ray, the CT scan takes multiple pictures and creates a more detailed view of the pelvic area.

Using a CT scan is a good way to get an overall look at a tumor, showing its location and size with ease. If the tumor is thought to be small, doctors may use a contrast medium, a special dye used in this procedure, to make the tumor show up on screen. The dye is nontoxic and either injected into a woman’s vein or swallowed as a pill.

CT scan technology is continuing to evolve, but it still has its limitations. Tumors or other abnormal masses that are smaller than 5 millimeters are still difficult to see.

MRI

The MRI — which stands for magnetic resonance imaging — works a lot like CT scans and x-rays. However, this test uses magnetic fields to create a detailed picture of the body. Contrast mediums are also used here to help doctors see an abnormality better.

Because of the similarity the MRI has to the CT scan and x-rays, it is possible that a woman’s doctor will order only one of these tests. If more pictures are needed, then an MRI may be ordered.

PET Scan

A positron emission tomography scan, also known as a PET scan, may be ordered if the above tests show that the tumor or abnormality may be cancerous. The PET scan works by injecting a woman with a radioactive sugar substance and looking at the results.

This substance was created to ensure that the most active cells within the body soak it up, thereby showing up on the scan. Because cancer cells use energy in an active way, they absorb this substance.

The scan produced after the substance is absorbed is an accurate picture of whether or not there is cancer present in a woman’s body. Doctors use this to determine if a tumor is cancerous.

Lower Gastrointestinal Series

A less common screening is the use of the lower gastrointestinal series. It is a series of x-rays that are conducted after a woman has a barium enema. A barium enema is when a woman receives a special dye that is introduced into the body through her anus.

The series is used to highlight the rectum and colon, making it easier to detect cancer or tumors that may be in that area. This is an important test, as many women who may be in stage 2 of ovarian cancer will have a mass or tumor that may block other forms of x-rays.

Biopsy

A biopsy is the last step in the screening process. It is an invasive procedure that involves a doctor removing tissue of a suspected tumor or mass for further examination. Because of the intrusive nature of the biopsy, it is only conducted after a battery of tests.

A biopsy provides a sample for doctors to look at under a microscope. If ovarian cancer is detected — or even suspected — the doctor might recommend a surgical removal of the tumor as quickly as possible.

In some cases, a biopsy is ordered if a cancer diagnosis is still uncertain or if the tumor is too large to remove all at once. At this stage, a woman will be asked to undergo a biopsy with the understanding that there is a high probability that she will have a cancer diagnosis and may need immediate treatment.

Risk Levels and Screening Recommendations

Women need to know that their risk level of developing ovarian cancer will impact their doctor’s screening recommendations. If she has a family history of ovarian cancer, has battled breast cancer in the past, has a BRCA gene mutation, or Ashkenazi Jewish ancestry, she is at high risk.

Women with the above family and genetic history should undergo an ovarian cancer screening starting at age 40. Her doctor, who will be privy to her information, will make sure to do a full pelvic exam at her annual checkup to ensure that she is not at risk. If she has abnormal pelvic exam results, the screening process may begin.

Women who are not at risk of developing ovarian cancer are advised by their doctors to not undergo screening. This, however, is dependent on her annual gynecological visit. If she, too, has abnormal pelvic exam results, their doctors may request a transvaginal ultrasound. If this test shows anomalies, her doctor may recommend a full ovarian cancer screening.
 
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Conclusion

Screenings are not always 100 percent accurate, but they do save lives. Even if a woman’s doctor believes that she does not need a screening, she should insist on one if she feels there is a possibility she has ovarian cancer.

But for all women, here is a word of caution — the screenings and tests described above work together to provide a full diagnosis. But that does not mean the diagnosis will be ovarian cancer. It is likely it might be another type of cancer altogether, or another disease, so try to keep an open mind.

Source List for Screening

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  2. Finding ovarian cancer early – Canadian Cancer Society. (n.d.). Retrieved February 29, 2016, from http://www.cancer.ca/en/cancer-information/cancer-type/ovarian/finding-cancer-early/?region=on
  3. Gallagher, J. (2015, December 17). Ovarian cancer: Screening may cut deaths by a fifth. Retrieved February 29, 2016, from http://www.bbc.co.uk/news/health-35111443
  4. How is Ovarian Cancer Diagnosed? (n.d.). Retrieved February 29, 2016, from http://www.ovarian.org/detection.php
  5. Ovarian cancer. (2014, October 10). Retrieved February 29, 2016, from http://www.mayoclinic.org/diseases-conditions/ovarian-cancer/expert-answers/ca-125/faq-20058528
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  7. Rettner, R. (2015, May 04). New Test for Ovarian Cancer Finds More Cases. Retrieved February 29, 2016, from http://www.livescience.com/50730-ovarian-cancer-screening-new-test.html
  8. Screening Guidelines. (n.d.). Retrieved February 29, 2016, from https://www.mskcc.org/cancer-care/types/ovarian/screening-guidelines-ovarian
  9. Screening Tests for Ovarian Cancer. (2014, August). Retrieved February 29, 2016, from http://www.choosingwisely.org/patient-resources/screening-tests-for-ovarian-cancer/
  10. UK Healthcare. (2009, April). Retrieved February 29, 2016, from http://ukhealthcare.uky.edu/Study-Screening-shows-promise-in-early-ovarian-cancer-detection/