Diagnosis of Ovarian Cancer Diagnosis
Ovarian cancer may not cause symptoms other than abdominal swelling. If the physician suspects ovarian cancer, a medical history, physical examination, and various tests will be performed to aid in the diagnosis.
Ovarian Cancer Screening
Screening is only successful if it decreases the mortality and morbidity of the disease. The screening procedure must detect the disease is in its early stages or in a precancerous stage without invasive features. Unfortunately, the available screening tests for ovarian cancer (e.g., CA-125, ovarian palpation, transvaginal ultrasound) are not sufficiently accurate for general screening. Therefore, screening for ovarian cancer is not recommended.
Medical History and Ovarian Cancer Diagnosis
In particular, the physician will ask about:
- Use of oral contraceptives (Women who use birth control pills are less likely to develop ovarian cancer.)
- Pregnancy and breast-feeding history (Women who have been pregnant are less likely to develop ovarian cancer; similarly, women who breast feed their infants are less likely to develop ovarian cancer.)
- Family history of ovarian cancer (Women are more likely to develop ovarian cancer if their immediate female relatives [e.g., mother, sister, daughter] have had ovarian cancer.)
- Previous gynecologic surgery (Women who have had a tubal ligation [surgical procedure in which the fallopian tubes are "tied" to prevent pregnancy] or hysterectomy [surgical removal of the womb without removal of the ovaries] are less likely to develop ovarian cancer.)
- Previous cancer history (Women are more likely to develop ovarian cancer if they already have had cancer of another organ; for example, the risk of ovarian cancer is twice as high among women who have been treated for breast cancer.)
During the medical history, questions also may be asked about smoking habits (some studies have suggested that there may be an association between smoking and ovarian cancer), as well as exposures to harmful occupational or environmental substances. If ovarian cancer is suspected, most physicians recommend consultation with a cancer specialist, such as a gynecologic oncologist (a physician who treats cancers of the female reproductive organs).
Pelvic Examination and Ovarian Cancer Diagnosis
The physician also performs a thorough examination of the abdomen and pelvic area. A pelvic examination includes palpation (feeling) for unusual growths, masses, or nodules, which are small masses of tissue. Two-handed palpation is used to feel for enlarged ovaries. During this procedure, the physician inserts gloved fingers into the vagina and palpates the skin over the ovaries with the other hand. Using palpation, the physician may detect a mass on either or both side(s) of the uterus. If the mass is larger than 2 inches (approximately 5 centimeters) in diameter, is solid rather than cystic (sac-like), or is bilateral (present on both sides), ovarian cancer may be present.
In addition, physician feels for nodules on the floor of the pelvis, which may indicate ovarian cancer. These nodules often are caused by ovarian tumor metastases to the peritoneum (membrane lining the pelvic cavity). If a tumor has spread to the omentum (fatty tissue that covers the bowels), part of its bulk may be felt in the upper abdomen.
Ovarian cancer may be suspected if a woman experiences abdominal swelling due to ascites; however, other illnesses (e.g., liver cirrhosis) also must be ruled out. In cases of ascites, fluid may be withdrawn by needle aspiration (suctioning fluid using a fine-bore needle). The fluid is then examined under a microscopt to detect cancer cells. In a procedure called culdocentesis, a needle is inserted through the vaginal wall and fluid is removed from the space surrounding the ovaries. If no fluid is present, several sites within the pelvic cavity may be flushed with sterile fluid to obtain cells for examination; paracentesis is a procedure to remove fluid from the abdominal cavity.
In addition, a Papanicolaou smear (Pap smear or Pap test) may be obtained during pelvic examination to detect cancerous cells. During this test, the physician employs a scraper or small brush to gather cells from the cervix and upper vagina. The cells are smeared on a slide and are sent to a laboratory to identify any abnormalities. The Pap test customarily is used to screen for cervical cancer; however, on rare occasions, cancerous ovarian cells are discovered when the slide is examined. Thus, although the Pap test is not dependable for the diagnosis of ovarian cancer, it may confirm an existing diagnosis.