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Ovarian cancer diagnosis

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on May 23, 2022.

While women of any age may develop ovarian cancer, it’s most commonly diagnosed in postmenopausal women between the ages of 55 and 64. In 2022, approximately 19,880 U.S. women will receive an ovarian cancer diagnosis, according to the American Cancer Society. 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.

How to test for ovarian cancer

Pelvic exam

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.

Transvaginal ultrasound

A transvaginal ultrasound is typically the first type of imaging test used if any issues with the ovaries are suspected. This diagnostic imaging test uses high-energy sound waves to help the care team see exactly what the patient's ovaries look like, including their size and interior appearance. It also helps detect abnormalities such as an ovarian tumor, which may look like a solid mass or a fluid-filled cyst. A transvaginal ultrasound may help visualize any suspicious characteristics of the ovaries, 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. An ultrasound may spot a mass, but it can’t determine whether that mass is malignant (cancerous) or benign (noncancerous).

A screening test for ovarian cancer hasn’t yet been developed. In early cases, ovarian cancer may go undetected even with a transvaginal ultrasound. It’s known as a “silent disease,” because it often doesn’t cause noticeable symptoms until it has spread. Doctors think ovarian cancer may originate in the fallopian tubes where changes are harder to detect.

Ovarian biopsy

In order to test for ovarian cancer, an ovarian biopsy  is required. Sometimes, the entire tumor may be surgically removed and tested.

However, if the cancer is advanced, or the patient has a medical condition that prevents her from having surgery to remove the tumor completely, a sample may be removed laparoscopically instead. This is performed using a needle guided by an ultrasound or a computed tomography (CT) scan, called a CT-guided needle biopsy. The needle is inserted into the tumor, and a sample is taken.

  • A fine-needle biopsy collects a very small portion of tissue.
  • A core-needle biopsy collects a larger, cylindrical portion of tissue.

In patients who experience a buildup of fluid in the abdominal region, a procedure called paracentesis may be performed. Paracentesis involves the removal of abdominal fluid by inserting a needle into the area. The procedure may be guided by ultrasound imaging.

A pathologist will examine the tissue or fluid sample taken from the biopsy or paracentesis procedure for the presence of cancerous cells.

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. (Although CT scans are useful in viewing larger tumors, small ovarian tumors don’t show up as well on these imaging tests.) A CT scan may also help determine tumor size and reveal whether the cancer has spread to other organs (such as the bladder or kidneys) or lymph nodes. These images may also help the doctor see whether the cancer has reached the bladder or kidneys.

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. Although an MRI is helpful in identifying areas of the brain and spinal cord where advanced cancer has spread, this imaging test is rarely used to detect ovarian cancer.

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.

Blood tests

The care team will likely perform standard blood tests to evaluate red and white blood cell levels, as well as platelet count. These blood tests also measure kidney and liver function and help gauge the patient's overall health.

Ovarian cancer tumor markers

Nutrition panel: This blood test measures deficiencies in 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.

CA-125: The cancer antigen 125 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.

HE4: The human epididymis protein 4 test measures the level of HE4 protein in the patient’s blood to detect ovarian cancer progression or monitor whether the treatment is working.

CA 19-9: The cancer antigen 19-9 assay measures whether the CA 19-9 protein is elevated to evaluate whether ovarian cancer is spreading or whether the treatment is working.

Abnormal levels of these proteins may be caused by 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. For example, a blood test may find high blood levels of the hormone inhibin in patients with an ovarian tumor. Patients with a germ cell cancer may have elevated levels of human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and/or lactate dehydrogenase (LDH). The care team may also order other tumor marker blood tests.

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
  • Barium enema X-ray or colonoscopy may be used to see whether cancer has spread to the colon.
  • Molecular testing for certain genetic changes may be recommended to help determine treatment options. In addition to tests for BRCA1 and BRCA2 gene mutations, doctors may test for elevated levels of gene changes called microsatellite instability (MSI) or changes in MMR genes, which are both found in patients with Lynch syndrome. They also may test for NTRK gene mutations, which are rare.

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Show references
  • American Cancer Society (2020, April 3). Tests for Ovarian Cancer.
    https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/how-diagnosed.html
  • van Nagell Jr JR, Hoff J. (2013, December 20). Transvaginal ultrasonography in ovarian cancer screening: current perspectives. International Journal of Women’s Health, 6:25-33.
    https://doi.org/10.2147/IJWH.S38347