Ovarian Cancer (cont.)
Andrew Green, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
How is ovarian cancer diagnosed?
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Often vague symptoms eventually lead to a clinical diagnosis, or one based on suspicion generated by exams, laboratory tests, and imaging. However, an accurate diagnosis requires some of the tumor to be removed, either by biopsy (less often), or preferably, surgery to verify the diagnosis. Often a high clinical suspicion can trigger a referral to a gynecologic oncologist.
Various types of imaging studies can be used to diagnose this disease. Ultrasound and CT (CAT) scans are the most common. These can often give pictures that show masses in the abdomen and pelvis, fluid in the belly (ascites), obstructions of the bowels or kidneys, or disease in the chest or liver. Many times this is all that is necessary to trigger a referral to a specialist, as the suspicion for ovarian cancer can be quite high. PET scans can be used, but often are not necessary if a CT scan is able to be performed.
Blood work can be helpful as well. The CA-125 is a blood test that is often, but not always, elevated with ovarian cancer. If a postmenopausal woman has a mass and an elevated CA-125, she has an extremely high risk of having a cancer. However, in younger women, CA-125 is extraordinarily inaccurate. It is elevated by a large number of disease processes, including but not limited to, diverticulitis, pregnancy, irritable bowel syndrome, appendicitis, liver disease, stomach disease, and more. No one should get this test done unless they actually have a mass, or their doctor has some reason to get it. It should not be drawn just to see the level since it is not a reliable screening test for ovarian cancer.
That being said, there is some new research that is developing that looks at following CA-125 over the life of a patient. In some very early work, there is a suggestion that by watching this trend closely we might be able to detect more cancers at an earlier stage. This has not yet been proven. As stated above, this can be a difficult decision process. Often it can lead women to have other unnecessary tests that can even lead them to unnecessary surgery. Until more work is done, it is currently recommended that CA-125 be drawn only in the setting of the discovery of a pelvic mass.
HE4 is another, newer blood test that is starting to be used while women undergo workup for a mass that has been found. It is commonly used to try to help decide if a referral to a gynecologic oncologist is warranted. When abnormal, in conjunction with a CA-125, it can assist in the decision process as to the risk of the mass being cancerous.
OVA-1 is a test that is performed by a private company. This test uses a series of blood tests, and then plugs the results into an equation that then gives the doctor a result about the likelihood that a mass is cancerous. A high level of the test has been shown in some studies to increase the suspicion of a cancer being present. This study is often not covered by insurance, and has not yet been adapted as a standard of care.
Reviewed by Melissa Conrad Stöppler, MD on 9/24/2013
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