Ovarian Cancer

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Questions to Ask Your Doctor About Your Cancer
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Diagnosis

Ovarian cancer may not cause symptoms other than abdominal swelling. If the physician suspects ovarian cancer, a medical history, physical examination, and various tests will be performed to aid in the diagnosis.

Medical History

In particular, the physician will ask about:

• Use of oral contraceptives (Women who use birth control pills are less likely to develop ovarian cancer.)
• Pregnancy and breast-feeding history (Women who have been pregnant are less likely to develop ovarian cancer; similarly, women who breast feed their infants are less likely to develop ovarian cancer.)
• Family history of ovarian cancer (Women are more likely to develop ovarian cancer if their immediate female relatives [e.g., mother, sister, daughter] have had ovarian cancer.)
• Previous gynecologic surgery (Women who have had a tubal ligation [surgical procedure in which the fallopian tubes are "tied" to prevent pregnancy] or hysterectomy [surgical removal of the womb without removal of the ovaries] are less likely to develop ovarian cancer.)
• Previous cancer history (Women are more likely to develop ovarian cancer if they already have had cancer of another organ; for example, the risk of ovarian cancer is twice as high among women who have been treated for breast cancer.)

During the medical history, questions also may be asked about smoking habits (some studies have suggested that there may be an association between smoking and ovarian cancer), as well as exposures to harmful occupational or environmental substances. If ovarian cancer is suspected, most physicians recommend consultation with a cancer specialist, such as a gynecologic oncologist (a physician who treats cancers of the female reproductive organs).

Pelvic Examination
The physician also performs a thorough examination of the abdomen and pelvic area. A pelvic examination includes palpation (feeling) for unusual growths, masses, or nodules, which are small masses of tissue. Two-handed palpation is used to feel for enlarged ovaries. During this procedure, the physician inserts gloved fingers into the vagina and palpates the skin over the ovaries with the other hand. Using palpation, the physician may detect a mass on either or both side(s) of the uterus. If the mass is larger than 2 inches (approximately 5 centimeters) in diameter, is solid rather than cystic (sac-like), or is bilateral (present on both sides), ovarian cancer may be present.

In addition, physician feels for nodules on the floor of the pelvis, which may indicate ovarian cancer. These nodules often are caused by ovarian tumor metastases to the peritoneum (membrane lining the pelvic cavity). If a tumor has spread to the omentum (fatty tissue that covers the bowels), part of its bulk may be felt in the upper abdomen.

Ovarian cancer may be suspected if a woman experiences abdominal swelling due to ascites; however, other illnesses (e.g., liver cirrhosis) also must be ruled out. In cases of ascites, fluid may be withdrawn by needle aspiration (suctioning fluid using a fine-bore needle). The fluid is then examined under a microscopt to detect cancer cells. In a procedure called culdocentesis, a needle is inserted through the vaginal wall and fluid is removed from the space surrounding the ovaries. If no fluid is present, several sites within the pelvic cavity may be flushed with sterile fluid to obtain cells for examination; paracentesis is a procedure to remove fluid from the abdominal cavity.

In addition, a Papanicolaou smear (Pap smear or Pap test) may be obtained during pelvic examination to detect cancerous cells. During this test, the physician employs a scraper or small brush to gather cells from the cervix and upper vagina. The cells are smeared on a slide and are sent to a laboratory to identify any abnormalities. The Pap test customarily is used to screen for cervical cancer; however, on rare occasions, cancerous ovarian cells are discovered when the slide is examined. Thus, although the Pap test is not dependable for the diagnosis of ovarian cancer, it may confirm an existing diagnosis.

Imaging Studies
A variety of imaging techniques may be performed to determine the size, shape, location, and consistency of the ovaries.

Ultrasound, an imaging method based on the principle that solids reflect sound waves in a manner that can be converted into a picture, is a valuable tool for the diagnosis of ovarian cancer. During ultrasound, a transducer probe releases high-frequency sound waves that bounce off the ovaries, are collected, and are transmitted onto a video screen to create a picture called a sonogram.

When the probe is placed on top of the abdominal wall, the process is known as transabdominal ultrasonography. When the probe is placed within the vagina, the process is known as transvaginal ultrasonography or transvaginal sonography (TVS).

The transvaginal method allows the probe to be placed closer to the ovaries, which improves the quality and resolution of the sonogram. Therefore, many experts prefer TVS as an imaging method for ovarian abnormalities; however, TVS does not distinguish cancerous masses from those caused by benign disease. The diagnostic potential of transvaginal sonography is improved when paired with the blood test known as CA125 (see also Laboratory Tests).

In addition to TVS, other imaging methods may be employed to visualize the ovaries. It is important to note that these methods alone do not guarantee an accurate diagnosis. Therefore, they usually are performed along with other tests such as needle aspiration cytology or CA125.

Computed tomography (CT or CAT scan) is an imaging technique in which an x-ray rotates around the body and takes pictures (scans) at numerous angles. Sometimes a special dye known as contrast medium is injected or consumed to highlight body parts during CT scanning (if ovarian cancer is suspected, contrast medium may be used to highlight the intestines and emphasize any spread of cancer within the pelvic cavity). A computer puts the scans together and creates detailed images of the body's organs in cross-section.

Magnetic resonance imaging (MRI scan) is another computer-assisted imaging method. It uses a powerful electromagnet to align water molecules within the body and create an internal picture.

Transvaginal color flow doppler is an ultrasound test that measures blood flow to the ovaries. As with TVS, a high-frequency probe is placed within the vagina. Blood measurements are displayed as graphs showing the resistance index (holding back of blood flow) and pulsatile index (speed of blood flow). In women with healthy ovaries or noncancerous disease (e.g., ovarian cyst), the ovaries are nourished by normal blood vessels. If an ovarian cancer is present, the tumor requires many new blood vessels for adequate circulation. Such new blood vessels offer little resistance to blood flow. Therefore, low resistance and pulsatile indexes suggest the presence of a cancerous tumor.

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