Physical Examination

 Physical findings are uncommon in

patients with early disease. Patients
with more advanced disease may
present with ovarian or pelvic mass,
ascites, pleural effusion, abdominal
mass or bowel obstruction.

Clinical Manifestations

 The primary reasons ovarian cancers

go undetected are that there is no
reliable screening test and the
symptoms are often not noticeable
and fairly non-specific, meaning there
are many non-cancerous conditions
that can cause similar symptoms and
often be difficult to tell apart.
 Symptoms of ovarian cancer are
nonspecific and may include increased
abdominal girth, pelvic pressure,
bloating, back pain, constipation,
abdominal pain, urinary urgency,
indigestion, flatulence, increased waist
size, leg pain, and pelvic pain.
 Ovarian cancer is often silent, but
enlargement of the abdomen from an
accumulation of fluid is a common sign.

Diagnostic Examination
 Pelvic examination, MRI scan, transvaginal and pelvic ultrasound, chest x-rays,
and a blood test for CA-125.

Laboratory Tests

Currently, there is no specific screening test for ovarian cancer. The U.S. Preventive
Services Task Force (USPSTF) recommends against screening women for ovarian
cancer. This recommendation applies to asymptomatic women (the general population)
but not to women at a high risk of developing ovarian cancer, such as those with a
known harmful (pathogenic) genetic variant (e.g., BRCA1/2 variant). Women with
increased risk may be monitored with a combination of transvaginal ultrasounds and
blood tests for the tumor marker CA-125.

The need for a reliable method for early detection of ovarian cancer among
asymptomatic women continues to drive ongoing research. Molecular (gene) tests and
multimarker approaches are being explored to improve early detection of ovarian
cancers. In the meantime, regular physicals, pelvic exams, and an awareness of family
history and symptoms are important.

Tests for increased risk

Women with a strong family history or ethnicity associated with ovarian cancer may
receive genetic counseling and have genetic testing done. A common example
is BRCA1 and BRCA2 testing. These tests detect harmful genetic variants that are
known to increase the risk of breast and ovarian cancer. Only about 0.2% of the U.S.
population carries a harmful BRCA1 or BRCA2 variant. Because of this, genetic testing
is not recommended for the general population.

Diagnosis

If an abnormality is found, such as a growth detected during an ultrasound, and ovarian

cancer is suspected, a biopsy is typically required to confirm the diagnosis. A sample of
the growth is removed during surgery and sent to the laboratory. A pathologist uses a
microscope to examine the sample and determine whether cancer is present.

Monitoring

 CA-125 (Cancer antigen 125) – this is a tumor marker primarily used to monitor

therapy during treatment for ovarian cancer. CA-125 is also used to detect
whether cancer has come back after treatment is complete. A series of CA-125
tests that shows rising or falling levels is often more useful than a single result.

 HE4 (Human epididymis protein 4) – a relatively new tumor marker that shows
promise. It may be used along with CA-125 to monitor women who have been
treated for epithelial ovarian cancer. In order for HE4 to be useful as a tumor
marker, it must be elevated prior to treatment.

Other tests may be ordered to help monitor different types of ovarian tumors. The tests
may help determine whether treatment (e.g., surgery, chemotherapy) is successful and
whether cancer has returned. Some examples include:

 Epithelial tumors

 Carcinoembryonic antigen (CEA) – less specific and sensitive than CA-

125; not recommended for routine use

 Germ cell tumors

 Alpha-fetoprotein (AFP)

 Human chorionic gonadotropin (hCG)

 Lactate dehydrogenase (LD)

 Stromal tumors
  Inhibin

 Estrogen

 Testosterone

Non-laboratory Tests

Imaging tests that may be used to evaluate the ovaries include:

 Ultrasound (pelvic and/or transvaginal) – uses sound waves to create a picture of

the uterus and ovaries; it can help determine whether an ovarian growth is likely
to be a cancer or a fluid-filled cyst.

 CT scan (computerized tomography) or X-rays may be used to see if the cancer

has spread.

 MRI (magnetic resonance imaging) may be used to see if the cancer has spread.