Diagnosing Ovarian Cancer

*Please note: This slide show is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult your doctor about any questions you may have regarding a medical condition.

Why is ovarian cancer challenging to diagnose?

Ovarian cancer is often not diagnosed until after it's begun to spread beyond the ovary because:

• When the cancer is in its early stages, you may not notice any symptoms
• Other conditions that are not cancer can cause the same symptoms

Is there a screening test for ovarian cancer?

Screening tests are used to detect cancer before it shows any symptoms. Today, there is no screening test that accurately detects ovarian cancer.

• The Pap test can screen for cervical cancer but not ovarian cancer
• A pelvic exam can check for enlarged ovaries or signs of fluid in the abdomen, but it can't screen for most early ovarian tumors

Is there a screening test for ovarian cancer?

Women with ovarian cancer may have high blood levels of a protein called CA-125.

But conditions like pregnancy, fibroids, or your monthly period can also cause higher than normal blood levels of CA-125. This means that CA-125 testing is not a reliable way to screen for ovarian cancer.

Is there a screening test for ovarian cancer?

A test called transvaginal ultrasound can show a mass in an ovary but can't tell if the mass is cancer.

Researchers are working on developing an accurate screening test for ovarian cancer.

Important hereditary genetic risk factors for ovarian cancer

Some women are at higher risk for ovarian cancer due to inherited genetic mutations that can be passed on by either parent. Even fathers can pass these on to daughters.

Important hereditary genetic risk factors for ovarian cancer

Inherited mutations in genes called BRCA1 and BRCA2 are the most common mutations that increase risk for both ovarian cancer and breast cancer.

Mutations in BRCA1 and BRCA2 genes are 10 times more common in women who have Ashkenazi Jewish ancestry.

Important hereditary genetic risk factors for ovarian cancer

Mutations in other, less common genes may also increase risk for ovarian cancer.

Lynch Syndrome, also known as HNPCC, is another genetic condition that can run in families. Lynch Syndrome increases risk for several cancers, including colon cancer, ovarian cancer, and endometrial cancer.

Knowing and sharing your family medical history – on both sides of the family – is an important way to help identify genetic conditions that increase cancer risk.

Genetic testing for ovarian cancer

Whether or not you have a family history of cancer, all women diagnosed with ovarian cancer should have access to genetic testing to see if it's a hereditary condition.

Knowing you have a genetic mutation may impact your treatment options.

For other family members who are diagnosed with a hereditary condition, tests to monitor for cancer can help reduce their risk.

Diagnosing ovarian cancer
Physical exam and health history

If ovarian cancer is suspected, your doctor will:

• Perform a pelvic exam
• Ask about your medical history and any history of cancer in your family
• Ask if you're having any symptoms and when they started, and
• Order blood tests

Diagnosing ovarian cancer
Gynecologic oncologist

Some tests look for high levels of substances in the blood called biomarkers that may indicate cancer. But conditions that are not cancer can also cause high levels of these substances.

If any of your blood test results suggest that you might have ovarian cancer, you should see a gynecologic oncologist.

Diagnosing ovarian cancer
Imaging tests

Your doctor should also order imaging tests, such as CT, PET or MRI. These tests can show if there's a growth but can't tell for sure if it's cancer.

Diagnosing ovarian cancer
Biopsy

A biopsy is the only way for sure to diagnose ovarian cancer. This involves removing tissue and looking at it under a microscope. A biopsy may be done before surgery to get a diagnosis, or during surgery when removing a mass.

Staging ovarian cancer

Staging describes the extent of cancer in the body. This helps with choosing the best treatment.

Like most cancers, ovarian cancer has four main stages.

• In Stage I, cancer is in one or both ovaries and may also be on the outer surface of the ovaries or in fluids in the abdomen
• In Stage II, cancer has spread to the fallopian tubes or other organs in the pelvis
• In Stage III, cancer has spread to the lymph nodes; to other places in the abdomen such as the lining, or peritoneum; or to the outer surface of the spleen or liver
• In Stage IV, cancer has spread to lymph nodes outside the abdomen or to inside the lungs, spleen, liver, or brain

Staging ovarian cancer
TNM system

The TNM system provides more information about the cancer by answering three questions.

• T: How large is the tumor?
• N: Has the tumor spread to nearby lymph nodes?
• M: Has the tumor spread (metastasis) to other organs in the body?

Grading ovarian cancer

Grading describes how the cancer cells look under a microscope and how fast they are growing.

• Low grade tumor cells look the most like normal cells and are slow-growing
• Moderate grade cancer cells look somewhat more abnormal and may grow or spread faster
• High grade cancer cells look very abnormal and are fast-growing

The microscopic pictures will also define the cancer cell type. There are many different types of ovarian cancer cells that behave differently.

Knowing your cancer's stage, grade and cell type will help your team plan the best treatment for you.

Talking with your healthcare team

If you have any questions about what your cancer stage or grade means, ask your doctor or another member of your healthcare team to explain it to you.

References

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   https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/detection.html
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   https://www.cancer.org/cancer/ovarian-cancer/causes-risks-prevention/risk-factors.html
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   https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/staging.html
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   https://labtestsonline.org/
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   https://labtestsonline.org/tests/carcinoembryonic-antigen-cea
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   https://labtestsonline.org/tests/lactate-dehydrogenase-ld
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   https://labtestsonline.org/conditions/lynch-syndrome
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13. National Ovarian Cancer Coalition. How Am I Diagnosed with Ovarian Cancer?
    https://www.ovarian.org/about-ovarian-cancer/how-am-i-diagnosed
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