Ovarian Cancer - Diagnosis

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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. 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.

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See what others are saying

Comment from: Julie, 65-74 Female (Patient) Published: April 11

I had a diagnosis of pneumonia. After many antibiotics, I got diarrhea. The doctor asked for stool specimens, but within hours, I never had another bowel movement. I went to ER after vomiting copious amount of black/green bile mixed with blood. A CT scan revealed a large abdominal mass blocking my lower colon. During a colonoscopy, they were unable to push the scope through the mass. A laparotomy revealed stage 4 ovarian cancer. I've had three treatments so far, and will get another CT scan to see if the cancer has shrunk enough to surgically remove the rest of it.

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Comment from: Cathy1, 65-74 Female (Patient) Published: May 14

I had severe chest pains and had tests that revealed an aneurysm in the ascending aorta, but the CT scan showed a tumor attached to my ovary. Blood test showed cancer markers are up. I am scheduled to have another CT scan in two days and removal of ovaries, fallopian tubes, uterus and cervix scheduled for next week. I still don"t know for sure that it"s cancer.

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