A doctor may advise a blood test to patients having ovarian cancer.
A doctor may advise a blood test to patients having ovarian cancer.

A doctor may advise a blood test to patients having ovarian cancer. A cancer antigen-125 (CA-125) blood test is usually recommended to measure the levels of a protein called CA-125, which could be elevated in women who have ovarian cancer. This test is also used during the treatment of ovarian cancer because the level of this protein goes down as the tumor shrinks. This protein is elevated in more than 80 percent of women with advanced ovarian cancers and 50 percent of those with early-stage cancers. However, this protein is also often elevated in other health conditions, such as pelvic inflammatory disease. So, it is less useful as a true screening test for ovarian cancer. As a result, doctors generally use the CA-125 blood test in combination with other screening methods that may include

Pelvic exam

  • A doctor or nurse examines the vulva and internal reproductive organs, such as the vagina, cervix, ovaries, fallopian tubes and uterus.
  • This exam requires the doctor to place one or two fingers into the vagina and another over the abdomen to feel the size, shape and position of the ovaries and uterus.
  • Ovarian cancer is rarely detected in a pelvic exam during the early stages.

Transvaginal ultrasound

  • A transvaginal ultrasound is used to examine the reproductive organs and bladder. This can often reveal if there are masses or irregularities on the surface of the ovaries and within cysts that form within the ovaries.
  • To administer the test, the doctor inserts a probe into the vagina. The probe sends off sound waves that reflect off body structures.
  • The waves are then received by a computer that turns them into a picture. The ultrasound alone is not an accurate way to screen for ovarian cancer.

Computed tomography (CT) scan

  • CT scans take cross-sectional images of the tissues and bones in the body.
  • CT scans help define the boundaries of a cancerous tumor and show the extent of tumor spread, helping a doctor determine where to operate.

These tests could provide definitive results when used in combination. The only way to confirm the presence of ovarian cancer suspected by the tests is through a surgical biopsy of the tumor tissue.

Surgery and biopsy

  • This is the only definitive way to determine if a patient has ovarian cancer.
  • A laparotomy or laparoscopy is performed depending on what the CT shows, how large the tumor is or how far the cancer has progressed.
  • A laparotomy is a surgical procedure involving a long incision (cut) in the wall of the abdomen to remove fluid and tissue, such as the ovaries, fallopian tubes, uterus and connecting tissue, depending on how far the cancer has spread.
  • Laparoscopic surgery uses a thin tube with a camera (a laparoscope) that allows the doctor to see and remove tissue.

What are the common tumor markers that help in diagnosing ovarian cancer?

Apart from CA-125, a few other common tumor markers may help in diagnosing ovarian cancer.

Alpha-fetoprotein (AFP)

  • Used in ovarian germ cell tumors
  • Used to assess stage, prognosis and response to treatment

Beta-human chorionic gonadotropin (Beta-hCG)

  • Used in ovarian germ cell tumors
  • Used to assess stage, prognosis and response to treatment

Human epididymis protein 4 (HE4)

  • HE4 can help diagnose ovarian cancer in a woman with symptoms and may be more sensitive than CA-125
  • It can also be used to assess the response to treatment and monitor for recurrence as well

Inhibin A and B

  • A hormone that is normally produced by ovarian tissue but may be elevated in certain types of ovarian cancer (mucinous epithelial carcinoma and granulosa cell tumors)
  • Can be used to assess the response to treatment and monitor for recurrence

Carcinoembryonic antigen (CEA):

  • A nonspecific substance, which is elevated in many tumors (including ovarian tumors) and may be used to evaluate response to treatment

QUESTION

Where does ovarian cancer occur? See Answer

What are the different types of ovarian cancer?

The four main types of ovarian cancer are

  1. Epithelial ovarian cancer
    • This starts in the epithelium (the cells that cover the ovary)
    • 9 out of 10 ovarian cancers are epithelial
  2. Germ cell and sex cord-stromal cell
    • Germ cell and sex cord-stromal tumors are rare gynecologic malignancies, comprising less than 15 percent of ovarian cancers combined
    • In general, these types of tumors affect young women and present in early-stage disease
  3. Sex cord-stromal cell cancers
    • These start in the cells that make female hormones and can happen at any age
    • Germ cell and sex cord cancers respond well to treatment
    • If only one ovary has cancer, it may still be possible for younger women to have children after treatment
  4. Borderline tumors:
    • A group of epithelial tumors that have a lower risk of spreading than other types of tumors

Ovarian cancer is known as the deadliest gynecological cancer because it is usually detected in its later stages of development. The main reason for this is the ovaries are located deep in the body cavity. Thus, the precancerous and early cancerous changes are not only difficult to medically detect but are also not obvious or apparent in all women.

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Medically Reviewed on 5/6/2021
References
DeNoon DJ. Symptoms Warn of Ovarian Cancer. WebMD. https://www.webmd.com/ovarian-cancer/news/20080623/symptoms-warn-of-ovarian-cancer