Ovarian Cancer: Diagnosis

Pictured: Dennis Chi & Richard Barakat Gynecologic Service Chief, Richard Barakat (right) and Deputy Chief, Dennis Chi, are part of a team that is advancing new approaches to diagnosing and treating ovarian cancer.

If your doctor suspects ovarian cancer, he or she will first perform a pelvic exam to feel for lumps or changes in and around the ovaries. Additional diagnostic tests may be necessary if your doctor finds a pelvic mass or abdominal swelling during your examination, particularly if you have felt persistent abdominal bloating or discomfort.

Following a pelvic exam, your doctor may perform a transvaginal ultrasound by inserting a special wand (called a transducer) into the vagina. Sound waves are emitted from the device and bounce off organs within the pelvis to help identify potential tumors. This kind of ultrasound is superior to a traditional abdominal ultrasound because it enables the technician to place the transducer close to the ovaries, thus allowing a more definitive diagnosis. In addition, a CT scan of the abdomen and pelvis is performed.

Blood Tests

The progress of ovarian cancer can be followed with a simple blood test that measures the level of the CA-125 protein, which is a kind of serum, or tumor marker. This protein is released by most epithelial ovarian cancer cells and also by a number of other cells, including those of many benign tissues. The CA-125 test is often used to aid diagnosis, monitor the effectiveness of treatment (particularly that of chemotherapy), and identify cancer recurrences.

Biopsy & Staging

If a pelvic exam and an ultrasound show an abnormality, your doctor may perform a biopsy by removing a sample of tissue from the ovary for microscopic examination. A pathologist will examine the sample to see if it contains precancer or cancer cells. This can help to determine the stage, or extent, of the cancer.

If the CT scan shows evidence of advanced ovarian cancer, surgery may be recommended as the next step without performing a biopsy.

Robotic Surgery

Although it is rarely used to treat ovarian cancer, in certain situations our specially trained surgeons may use an advanced robotic device — called the da Vinci® Surgical System — to biopsy and stage ovarian cancer. To use the robot, the surgeon is seated at a multifunctional console positioned next to the patient. The surgeon views the area of the operation on the console via a magnified, three-dimensional, high-definition visual system. The surgeon performs the operation at the console using finger and foot controls, and the robot precisely copies his or her every movement. As the surgeon uses the robot to operate, the surgical team at the bedside monitors the patient throughout the procedure, assisting as necessary.

Another way to diagnose ovarian cancer is through a surgical procedure known as laparotomy. In laparotomy an incision is made into the abdominal region, the tumor is biopsied and staged, and any visible disease is removed.

For a more detailed description of ovarian cancer surgery, visit Treatment.

Minimally Invasive Surgery

If the tumor appears to be confined to the ovary, your doctor may recommend a minimally invasive procedure called laparoscopy for biopsy and tumor removal. A thin, lighted tube with a camera at its tip (called a laparoscope) is inserted through a tiny incision in the abdominal wall. Guided by the highly magnified image generated by the camera, the surgeon can take a sample of the tissue using specially designed surgical instruments. Like the open surgical procedure laparotomy, laparoscopy can be used to stage (to determine the extent of the tumor) and to remove cancerous tissue.

Imaging Tests

If initial tests indicate a diagnosis of ovarian cancer, your doctor may order additional procedures to determine if the cancer has spread, or metastasized, elsewhere in the body. He or she might recommend a cytoscopy (examination of the bladder using a lighted tube), proctoscopy (examination of the rectum), a chest x-ray, or other imaging tests — such as ultrasound, CT, MRI, or PET, if they have not already been performed.

Two other diagnostic imaging tests used for ovarian cancer are barium enema and intravenous pyelogram. For the former, a silver-white metallic compound known as barium is injected into the rectum and colon through the anus. Barium helps to show the image of the lower gastrointestinal tract on an x-ray. An intravenous pyelogram is a series of x-rays of the urinary system (kidneys, ureters, and bladder) taken after a contrasting agent, or dye, is injected into a blood vessel.

Investigational Approaches

Women diagnosed with early-stage ovarian cancer are likely to have a markedly improved survival, and we are interested in new detection methods that employ blood testing or imaging techniques to identify early cancers with a high degree of reliability.

Protein tumor markers such as CA-125 and CA 15-3 — which are found on the surface of ovarian cancer cells — are already being used to track the progression of later-stage ovarian cancer. Another protein known as YKL-40 is being evaluated as a potentially novel marker for the detection of early-stage ovarian cancer. Future studies are being planned to learn more about the ability of YKL-40 levels to predict which tumors are responding to treatment and which are most likely to return.