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 CA-125, and to measure complete blood count and levels of chemicals in the blood
• use of an endoscope to see inside the gastrointestinal tract, such as a colonoscopy.
• Surgery to visualise the tumour and take samples of abnormal areas (biopsy) to diagnose and/or stage the cancer
• Molecular tests and genetic testing to look for any inherited mutations to guide management 

The only way to confirm a diagnosis of ovarian cancer is through a biopsy, usually done by surgery. During surgery, the doctor takes a biopsy – where a small sample of tissue is removed to be examined under a microscope. The surgeon will also take samples of any fluid in the abdomen. These samples will be used to stage the cancer. 

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. 

Ovarian cancer is divided into 4 main stages: 

• Stage I: the cancer is in 1 or both ovaries or fallopian tubes and has not spread to other organs or tissues.
• Stage II: the cancer is in 1 or both ovaries or fallopian tubes and has spread to other nearby organs in the pelvis, such as the uterus,, bladder or colon.
• Stage III: the cancer is in 1 or both ovaries or fallopian tubes 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 several substages. 

Genetic testing

Epithelial ovarian cancer can have a genetic link, meaning you might have inherited certain gene mutations from your mother’s or father’s side of the family. 

Genetic testing looks for mutations in genes that are known to cause ovarian cancer. Information from genetic testing can help to: 

• make decisions about which treatments to use
• assess and manage the woman’s risk of developing other cancers
• help manage the risk of ovarian cancer and other cancers in family members, if a mutation is discovered.  

In Australia, less than 5% of women with epithelial ovarian cancer are found to have mutations in their BRCA1 and BRCA2 genes.^[5] Epithelial ovarian cancer can be caused by mutations in genes involved in Lynch syndrome, but this is less common. 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 should have their genetic risk assessed. These women may be offered genetic testing if they meet certain clinical, personal and/or family history criteria.