How is ovarian cancer diagnosed?

A number of tests may be done to investigate symptoms of ovarian cancer and confirm a diagnosis. The more common tests include:

physical examination of the abdomen and pelvis, including rectal examination.
imaging of the pelvis and abdomen using transvaginal ultrasound, abdominal ultrasound, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans or positron emission tomography (PET) scans
chest X-rays
blood tests to check for tumour markers such as CA125, and to measure complete blood count and levels of chemicals in the blood
use of scopes to see inside the gastrointestinal tract
biopsy – where a small sample of tissue is removed to be examined under a microscope. This is usually done as part of the initial surgery, because the only way to confirm a diagnosis of ovarian cancer is through an operation. The surgeon will also take samples of any fluid in the abdomen.

Staging

Ovarian cancer is surgically staged, based on the extent of the cancer. Knowing the stage of the disease helps your medical team plan the best treatment for you.

Surgical staging involves taking biopsy samples from tissues and organs that ovarian cancer often spreads to.

Ovarian cancer is divided into 4 main stages:

Stage I: the cancer is in 1 or both ovaries and has not spread to other organs or tissues.
Stage II: the cancer is in 1 or both ovaries and has spread to other organs in the pelvis, such as the uterus, fallopian tubes, bladder or colon.
Stage III: the cancer is in 1 or both ovaries and has spread outside the pelvis to other parts of the abdomen or nearby lymph nodes.
Stage IV: the cancer has spread to other parts of the body beyond the pelvis and abdomen, such as the lungs or liver.

Each stage has a number of substages.

Genetic testing

Epithelial ovarian cancer can sometimes be caused by one or more faulty genes. Faulty genes may be inherited from the mother’s or father’s side of the family.

Genetic testing looks for faulty genes that are known to cause ovarian cancer. Knowing whether a woman has a faulty gene can help in making decisions about which treatments to use. Information from genetic testing can also help to assess and manage the woman’s risk of developing other cancers. If a faulty gene is found, this information can also help manage the risk of ovarian cancer and other cancers in family members.

Epithelial ovarian cancer can be caused by faults in BRCA1 and BRCA2 genes. Faults in BRCA1 and BRCA2 genes are found in one in seven women with epithelial ovarian cancer in Australia. Less commonly, epithelial ovarian cancer can be caused by faults in genes involved in Lynch syndrome. Lynch syndrome is an inherited condition associated with increased risk of endometrial, colorectal, ovarian and other cancers.

Women who have been diagnosed with epithelial ovarian cancer, regardless of their age or family history, should be offered assessment of their genetic risk. These women may be offered genetic testing if they meet certain specific clinical, personal and/or family history criteria.