The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

Diagnosing ovarian cancer

While women of any age may develop ovarian cancer, it’s most commonly diagnosed in postmenopausal women between the ages of 55 and 64. Some symptoms of ovarian cancer may be subtle and mimic common digestive issues.

Finding an appropriate treatment plan starts with an accurate diagnosis. Gynecologic oncologists use a variety of tools to diagnose ovarian cancer and determine the type and stage of the disease.

Pelvic exam for ovarian cancer

Pelvic exams are done routinely by a primary-care doctor, who may be an obstetrician-gynecologist. This exam may include both a visual and a physical assessment of internal sexual organs. The doctor feels for an enlarged ovary and any signs of fluid in the abdomen as part of a regular pelvic exam. This is the same exam that may detect conditions such as pelvic inflammatory disease, candidiasis, cervical polyps, uterine fibroids, genital warts, bacterial vaginosis and some gynecologic cancers.

During a pelvic exam, the doctor inserts two gloved fingers of one hand into the vagina and places the other hand on the abdomen to check the size, shape and consistency of the ovaries and uterus. He or she may also perform a rectovaginal pelvic exam, with one finger in the vagina and another in the rectum.

Detecting ovarian cancer through a pelvic exam alone is rare, especially in the early stages of the disease. Other diagnostic tests may be necessary.

Imaging tests for ovarian cancer

Transvaginal ultrasound (TVUS)

This diagnostic imaging test, which is the most common test used to screen for ovarian cancer, uses high-energy sound waves to detect abnormalities including an ovarian tumor, which may appear as a solid mass or a fluid-filled cyst. A transvaginal ultrasound may help visualize the size of the ovaries and any suspicious characteristics, along with any irregularities in the vagina, uterus, bladder and fallopian tubes.

During the test, a doctor or ultrasound technician inserts a probe into the vagina to capture images of the different organs and tissues.

Ovarian biopsy

An ultrasound may spot a mass, but it can’t determine whether that mass is cancerous or benign. That requires a biopsy. When ovarian cancer is suspected, the entire tumor may be removed and tested.

Computed tomography (CT) scan

After conducting a physical exam and, in some cases, an ultrasound, doctors may use a CT scan to locate a tumor before surgery. A CT scan may also help determine tumor size, as well as reveal whether other organs are affected or lymph nodes are enlarged.

Magnetic resonance imaging (MRI)

An MRI is often used in combination with other tests as part of the diagnostic evaluation process. An MRI has greater soft tissue contrast than a CT scan, making it useful in detecting tumors or recurrences in other areas of the body.

Positron emission tomography–computed tomography (PET/CT) scan

This technology is sometimes used to help diagnose ovarian, fallopian tube or peritoneal cancer. The scan measures a tumor's ability to use glucose, which is a type of sugar. Faster-growing cells use more sugar and show up brighter on a PET/CT scan. This may indicate the presence of cancer before it’s detected by other means.

Lab tests for ovarian cancer

Blood tests

CA-125: This assay measures the level of the CA-125 protein in the blood. CA-125 is a biomarker that may signal the presence of ovarian cancer cells. However, abnormal levels may be due to other conditions, so test results aren’t definitive on their own. Other blood tests may be performed if certain types of tumors are suspected, because these may cause elevated levels of various blood markers.

Nutrition panel: With this blood test, patients are evaluated for deficiency of nutrients, such as vitamin D and iron. The test helps identify which nutrients patients need replaced or boosted to support their quality of life and help reduce the risk of complications from surgery.

Genetic testing

If ovarian cancer is diagnosed, genetic testing may be recommended to determine whether a patient has inherited genes or gene mutations linked to ovarian cancer. These variants include the well-known BRCA1 and BRCA2 mutations linked to breast cancer, as well as ones called ATM, BRIP1 and MSH2. Results may determine whether a patient is at risk for other types of cancer and help guide treatment.

Additional testing

When tested for ovarian cancer, patients may also be checked for fallopian tube cancer and primary peritoneal cancer—all three cancers form in the same tissue.

Doctors may need additional testing to get a more complete picture of the nature of the cancer and whether it’s spread. These tests may include:

  • X-ray, which may help determine whether cancer has spread to the lungs
  • CT scan, which may help determine whether cancer has spread to other organs
  • PET scan, which may be conducted at the same time as a CT scan, to look for signs of cancer in lymph nodes or other parts of the body
  • MRI, which may help determine whether the cancer has spread to the brain or spinal cord