Ovarian Cancer - Diagnosis

Once a growth is detected, additional tests as outlined below may help the physician gauge the risk for it being cancerous.

Transvaginal Ultrasound and Other Imaging Tests

Ultrasound. Ultrasound is a noninvasive diagnostic tool that is used to evaluate tumors and masses discovered during the rectovaginal exam:

Typically, a probe is placed in the vagina that emits sound waves (ultrasound), which bounce off tissues, organs, and masses in the pelvic cavity. These echoes are collected and converted into a picture of the area called a sonogram.

Click the icon to see an image of transvaginal ultrasound.

The ultrasound probe may also be placed on abdominal walls above the ovaries (transabdominal ultrasound), but it does not provide as clear a picture of the ovaries. Healthy tissue, fluid-filled cysts, and solid tumors produce different sound waves.

Unfortunately, ultrasound does not provide enough specific information to reliably determine which abnormal masses are malignant and which are benign.

Studies suggest that small so-called simple cysts (fluid-filled without an associated mass) are usually noncancerous, particularly when they appear in premenopausal women whose blood tests for the protein CA-125 are normal. Such women are sometimes given oral contraceptives and observed for a few months to see if the cyst goes away.
Postmenopausal women with small simple cysts and normal CA-125 levels may sometimes be observed for a time if they have no other risk factors or symptoms of ovarian cancer.
In contrast, a "complex" cyst (one that shows a mass or other abnormalities) is often surgically removed, since it has a higher chance of being malignant. It should be noted, however, that even among these cysts only about a small percentage turn out to be malignant. (In one study 6% of complex cysts were actually cancerous.)

Click the icon to see an image of an ovarian cyst.

Other Imaging Techniques. Other imaging techniques used less commonly in the diagnosis or evaluation of suspected ovarian cancer include the following:

Computed tomography (CT). Computed tomography records X-ray absorption rates of tissue and bone. This data is converted into clear images on a screen. CT scans are useful to determine if cancer has spread to the lymph nodes, abdominal organs, abdominal fluid, and the liver.

Click the icon to see an image of a CT scan.

Magnetic resonance imaging (MRI). MRI creates multiple cross-sectional images of the pelvis and abdominal organs, which are assembled into three-dimensional images. They are being investigated for preoperative assessment of patients with possible ovarian cancer. Their value is undefined, however, and most patients do not require them prior to undergoing a definitive surgical procedure.