Booklet: What You Need to Know about Ovarian Cancer

Diagnosis and Staging

To find the cause of any of these symptoms, the doctor asks about the woman's medical history and does a careful physical exam, including a pelvic exam. The doctor feels the vagina, rectum, and lower abdomen for masses or growths. A Pap smear (a common test for cancer of the cervix) is often part of the pelvic exam, but it is not a reliable way to find or diagnose ovarian cancer. The doctor may also order other tests:

• Ultrasonography is the use of high-frequency sound waves. These waves, which cannot be heard by humans, are aimed at the ovaries. The pattern of the echoes they produce creates a picture called a sonogram. Healthy tissues, fluid-filled cysts, and tumors produce different echoes.
• CT (or CAT) scan is a series of x-rays put together by a computer.
• A lower GI series, or barium enema, is a series of x-rays of the colon and rectum. The pictures are taken after the patient is given an enema with a white chalky solution containing barium. The barium outlines the colon and rectum on the x-ray, which helps the doctor see tumors or other abnormal areas.
• An intravenous pyelogram (IVP) is an x-ray of the kidneys and ureters, taken after the injection of a dye.

Often, the doctor orders a blood test to measure a substance in the blood called CA-125. This substance, called a tumor marker, can be produced by ovarian cancer cells. However, CA-125 is not always present in women with ovarian cancer, and it may be present in women who have benign ovarian conditions. Thus, this blood test cannot be used alone to diagnose cancer.

The only sure way to know if cancer is present is for a pathologist to examine a sample of tissue under the microscope. Removing tissue from the body for this examination is called a biopsy. To obtain the tissue, the surgeon does an operation called a laparotomy. If cancer is suspected, the surgeon removes the entire ovary (oophorectomy). This is important because, if the problem is cancer, cutting through the outer layer of the ovary could allow cancer cells to escape and cause the disease to spread. If cancer is found at this time, the surgeon proceeds with surgery.

During surgery, the surgeon removes nearby lymph nodes, and takes samples of tissue from the diaphragm and other organs in the abdomen. The surgeon also collects fluid from the abdomen. All of these samples are examined by a pathologist to check for cancer cells. This process, called surgical staging, is needed to find out whether the cancer has spread. Staging is important in the planning of followup treatment.

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