Ovarian cancer develops in the ovaries, the reproductive organs that produce eggs. Its diagnosis can be challenging because the initial signs are often subtle and can be attributed to more common, less serious conditions. This ambiguity can delay diagnosis. An early diagnosis is associated with more manageable treatment, making awareness of the evaluation process beneficial for proactive health management.
Recognizing Early Symptoms
The earliest signs of ovarian cancer are frequently mistaken for digestive issues or normal menstrual cycle discomfort. The most common symptoms include persistent bloating, a noticeable swelling or tightness in the abdomen that does not resolve, and pelvic or abdominal pain. This pain is often described as a new type of discomfort that occurs most days and can worsen over time. Some individuals may also find they have difficulty eating or feel full very quickly.
Another set of symptoms involves changes in urinary habits, such as an increased urgency or frequency of urination without an apparent cause. What distinguishes these potential signs from everyday ailments is their persistence and newness. The symptoms occur almost daily for more than a few weeks and represent a change from what is normal for the individual. Keeping a detailed log of these occurrences can be a helpful tool when speaking with a healthcare provider.
Initial Diagnostic Evaluation
When symptoms suggest the possibility of ovarian cancer, a doctor’s first step is a physical and pelvic exam. During the pelvic exam, a provider will feel for any lumps, masses, or other changes in the pelvic region. While this examination can sometimes identify an abnormality, many individuals with early-stage ovarian cancer have a normal pelvic exam, so further tests are necessary if symptoms persist.
Following the physical exam, a transvaginal ultrasound is a common next step. This imaging procedure uses a small probe placed in the vagina to generate images of the ovaries, uterus, and fallopian tubes. This test can effectively identify a mass on an ovary but cannot determine if the mass is cancerous or benign.
The CA-125 blood test measures the level of a protein called cancer antigen 125, which can be elevated in women with ovarian cancer. However, this test is not used for diagnosis on its own because other conditions, such as endometriosis or pelvic inflammatory disease, can also cause elevated levels. These initial tests are used together to build a picture of suspicion rather than to provide a final answer.
Procedures for Definitive Diagnosis
While the initial evaluation can indicate the likelihood of ovarian cancer, the only way to confirm the diagnosis is through a biopsy. A biopsy involves taking a small sample of tissue from the ovarian mass, which is then examined under a microscope by a pathologist to check for cancer cells. This examination confirms the diagnosis and determines the specific type of ovarian cancer, which informs treatment decisions.
The tissue sample for a biopsy is almost always obtained during a surgical procedure. The two common surgical approaches are laparoscopy and laparotomy. A laparoscopy involves making small incisions in the abdomen to insert a camera and surgical tools, allowing the surgeon to view the pelvic organs and remove a small tissue sample or small tumors. A laparotomy requires a larger abdominal incision, which gives the surgeon the ability to remove larger tumors and take tissue samples from surrounding areas.
It is widely recommended that these surgical procedures be performed by a gynecologic oncologist, a surgeon who specializes in cancers of the female reproductive system. These specialists are trained to perform the complex staging and tumor removal surgeries required for ovarian cancer, and their expertise leads to more accurate staging and better surgical outcomes.
Screening for High-Risk Individuals
It is important to distinguish between diagnosis in people with symptoms and screening for those without them. Currently, routine ovarian cancer screening is not recommended for women at average risk. Studies show that screening this population leads to unnecessary procedures without reducing the number of deaths from the disease.
The screening approach is different for individuals at higher risk. This category includes those with a strong family history of ovarian, breast, or pancreatic cancer, or a known inherited genetic mutation. The most well-known of these mutations are in the BRCA1 and BRCA2 genes. Other genetic conditions, like Lynch syndrome, also place a person in this high-risk group.
For these individuals, a more proactive screening strategy may be offered, though its effectiveness in preventing deaths is still under investigation. These protocols often involve regular transvaginal ultrasounds and CA-125 blood tests, sometimes starting as early as age 30 or 35. Risk-reducing surgery to remove the ovaries and fallopian tubes is another option that high-risk individuals might consider.