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How is ovarian cancer diagnosed?
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 and lead to tissue sampling. Ultrasound and CT scans are the most commonly done studies. These often can give images that show masses in the abdomen and pelvis, fluid in the abdominal cavity (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.
HE4 is another blood test that is used in the U.S. to monitor patients with ovarian cancer to see if their cancer has recurred. Like CA-125, the HE4 test does not always detect cancer.
OVA-1 is a test that is performed by a private company. This test uses a series of blood tests, and then incorporates the results into an equation that then gives the doctor a result about the likelihood that a mass is cancerous. A high value for the test has been shown in some studies to increase the probability that a cancer is present. This test aids a doctor in planning for surgery when a mass is found.