Ovarian Cancer Diagnosis
Symptoms of ovarian cancer can be vague but may include unusual bloating and changes in bowel function—such as gas, indigestion, or constipation—that don’t resolve after two weeks and often get worse. If you notice these symptoms, talk to your gynecologist.
If your symptoms as well as the results of a physical exam and imaging tests suggest you might have ovarian cancer, your gynecologist can refer you to a gynecologic oncologist right away.
A gynecologic oncologist is a doctor who completes specialized training in diagnosing and treating cancers that develop in a woman’s reproductive organs. At NYU Langone’s Perlmutter Cancer Center, your gynecologic oncologist serves as the captain of the gynecologic cancer care team. It is important to consult with a gynecologic oncologist before treatment starts so that the best approach to cancer care can be recommended to you.
Types of Ovarian Cancer
While there are many types of ovarian cancer, the most common are grouped into three main categories, based on the types of cells from which tumors originate.
Epithelial cancer is the most common type of ovarian cancer. It develops from the cells that cover the ovary and line the fallopian tubes, also known as the epithelial cells.
Germ cell tumors develop from reproductive cells—those that turn into eggs.
The third category, called stromal ovarian cancer, arises in the connective tissue found in the ovary.
To help diagnose ovarian cancer, our doctors may order imaging tests and blood tests. If ovarian cancer is suspected, our doctor may also perform a biopsy—the removal of tissue for examination under a microscope for signs of cancer—during surgery. Rarely, another type of biopsy called a needle or core biopsy may be necessary.
In a transvaginal ultrasound, sound waves are used to create images on a computer monitor of your ovaries and fallopian tubes.
During the procedure, a wand-like device is inserted into the vagina to help doctors look for possible cancer in the ovaries and nearby organs, including the uterus. If a suspicious growth is found, doctors may order further imaging tests to see if a potential cancer has spread.
A CT scan is a form of X-ray in which a computer creates cross-sectional, three-dimensional pictures of the body. It can provide detailed views of an ovarian tumor. The scan also can detect whether there is any fluid in the abdomen, which might mean cancer has spread there.
This test can help determine whether a tumor has spread to the uterus, or area lymph nodes, which are immune system organs that trap invaders such as viruses and bacteria. Cancer often spreads to the lymph nodes first. The test can also reveal whether the tumor has spread to more distant organs, such as the liver, bladder, or kidneys.
A CT scan can help your doctor determine if you are a candidate for debulking or cytoreduction surgery. With this procedure, surgeons remove as much of the ovarian tumor as possible.
Your doctor may order blood tests to check for elevated levels of proteins that may indicate ovarian cancer is present, and what type it may be. For example, epithelial ovarian cancer may produce elevated levels of the protein CA-125 or HE4. Other proteins indicate that the tumor may be a germ cell cancer, while some stromal tumors cause levels of the hormone estrogen to rise.
If imaging tests and CA-125 tests give doctors a strong indication that ovarian cancer is present, they can perform a surgical assessment to confirm a diagnosis and often treat the cancer at the same time. During surgery, a gynecologic oncologist performs a tissue biopsy, meaning he or she removes the ovarian tumor and any surrounding tissue that may be cancerous. A pathologist immediately evaluates it under a microscope in the operating room for signs of cancer.
If the tissue is cancerous, the surgeon continues to remove as much of the surrounding cancer as possible.
Needle or Core Biopsy
If imaging tests suggest that you have ovarian cancer but your doctor needs more information before recommending surgery, he or she may refer you to an interventional radiologist, who can perform a needle or core biopsy.
For this procedure, a needle attached to a syringe is inserted into a tumor using ultrasound or CT guidance. This tissue can be examined under a microscope for signs of cancer.
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