5 Ways to Diagnose Ovarian Cancer

Dr. Liping Shen (Gynecologic Oncologist)

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Job Title: Gynecologic Oncologist & Expert Medical Author
Institutional Affiliation: Peking University International Hospital (Beijing, China)
Specialties: Gynecologic Oncology | Cervical & Ovarian Cancer Protocols | Reproductive Health Care

Dr. Liping Shen is an accomplished Gynecologic Oncologist who specializes in the clinical diagnosis, treatment protocols, and long-term care management for gynecological malignancies, including ovarian, cervical, and endometrial cancers. At Healthy Post, she directly authors and develops highly reliable, evidence-based health guidance, empowering women to make informed decisions regarding their reproductive and oncological health.

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Ovarian cancer is a common malignant tumor of the female reproductive organs, and its incidence has been increasing in recent years. In addition, due to the special location of the ovaries, which are deep in the abdomen. It is often discover in the late stage, and the cancer cells have spread to other organs in the abdomen, making it difficult to cure.

About 20% of ovarian cancers are discover in the early stages. If early ovarian cancer has not metastasized, the patient’s 5-year survival rate after diagnosis can be as high as 94%. So, what are the diagnostic methods for ovarian cancer?

▲Transvaginal ultrasound (TVUS)

TVUS uses ultrasound echoes to transmit imaging images and can help identify potential growths on the ovaries and determine if they are solid growths or cysts (cysts are noncancerous, fluid-filled sacs). If a solid mass is found, your doctor may order a biopsy to determine whether the mass is benign or malignant.

Ultrasound is fast, economical, non-invasive, and repeatable, and is the preferred examination method. However, the morphology, internal structure, and relationship with surrounding tissues of smaller ovarian masses are often unclear, and it is difficult to detect solid tumors with a diameter of less than 1 cm.

▲ CA-125 blood test

The CA-125 blood test measures the amount of CA-125 protein in the blood. Many women with ovarian cancer have elevated levels of CA-125 in their blood.

Not every ovarian cancer patient has elevated CA-125 levels in their blood. According to the Ovarian Cancer Research Fund Alliance (OCRFA), approximately 80% of patients with advanced ovarian cancer have elevated CA-125 levels, while 50% of patients have elevated CA-125 levels in the early stages of the disease. In addition, patients with other diseases such as pelvic inflammatory disease and endometriosis may also have elevated CA-125 levels in their blood.

▲ Computed tomography

CT scans use special x-rays to scan the abdomen. The results are process by a computer to create cross-sectional images that allow doctors to see various parts of the abdominal cavity and pelvis. CT examinations can locate and characterize pelvic tumors and determine whether there is metastasis to the liver, lungs, and retroperitoneal lymph nodes. Pelvic lymph node angiography can determine whether ovarian tumors have metastasized to the lymph nodes.

However, there is no significant difference in the CT appearance of primary ovarian tumors and metastatic tumors.

▲ Magnetic resonance imaging (MRI)

MRI has high soft tissue resolution, can be image in multiple planes, and is non-invasive. It is very advantageous in observing the depth of endometrial lesions invading the myometrium and the boundary between cervical tumors and the bladder or rectum, and plays an important role in the diagnosis and differential diagnosis of pelvic lesions of ovarian cancer.

However, the cost of MRI is higher than that of CT, and patients with intrauterine devices must wait until they have them removed before undergoing MRI.

▲ Histopathological examination

Cytological examination of ascites extracted by abdominal or posterior fornix puncture is helpful for the diagnosis of ovarian malignancy. The biopsy result is an important factor in the final diagnosis of ovarian cancer.

▲Diagnosing ovarian cancer, how to choose among various examination methods?

Histopathology is still the gold standard for diagnosis. Various imaging and histological examination methods have their own advantages and disadvantages, and should be use in combination to maximize their strengths and minimize their weaknesses.

Clinicians need to understand that imaging is only part of the diagnostic toolkit. Diagnosis of disease must be based on medical history, gynecological examination, laboratory tests, etc. A comprehensive assessment is need to give patients the best treatment strategy.

Because the symptoms of ovarian cancer are similar to those of many other diseases, it’s easy for patients to ignore them. Plus, the ovaries are located deep in the abdomen, making it difficult even for doctors to detect tiny growths on the organs.

Therefore, those with a family history of breast, ovarian, uterine, or colon cancer should consult a doctor promptly if they experience any unexplained severe pelvic or abdominal symptoms that last for more than 2 weeks.

Frequently Asked Questions About Ovarian Cancer Diagnosis and Treatment

1. Can a standard Pap smear diagnose ovarian cancer?

No, a standard Pap smear does not screen for or diagnose ovarian cancer. Pap smears are specifically designed to collect cells from the cervix to detect cervical cancer or precancerous cervical changes. Ovarian cancer develops deep within the pelvis, meaning different diagnostic tools—such as transvaginal ultrasounds and specialized blood tests—must be utilized to find it.

2. What is the CA-125 blood test, and how is it used in diagnosing ovarian cancer?

The CA-125 test measures the amount of a protein called cancer antigen 125 in your blood. While many women with ovarian cancer have elevated CA-125 levels, this test alone cannot confirm a diagnosis. Levels can also rise due to non-cancerous conditions like uterine fibroids, endometriosis, or pelvic inflammatory disease. Doctors use it alongside imaging tests to evaluate suspicious pelvic masses or monitor how well treatment is working.

3. Why is pelvic imaging, like a transvaginal ultrasound, necessary?

A transvaginal ultrasound (TVUS) is usually the first imaging step if an ovarian abnormality is suspected. By inserting a small probe into the vagina, the test allows gynecologic specialists to look closely at the size, shape, and structure of the ovaries. This helps doctors determine whether a growth or cyst is solid, fluid-filled, or complex, which helps gauge the likelihood of a malignancy.

4. What are the primary treatment options available for ovarian cancer?

The cornerstone treatments for ovarian cancer are surgical removal and systemic chemotherapy. Surgery is typically performed by a gynecologic oncologist to remove as much of the tumor as possible (debulking) and may include removing the ovaries, fallopian tubes, and uterus. Chemotherapy is then used either before surgery to shrink the tumors or after surgery to target any remaining microscopic cancer cells.