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How We Diagnose Ovarian Cancer

  • Testing for ovarian cancer

    Ovarian cancer is no longer considered just one type of cancer. There are several subtypes of ovarian cancer, and identifying those types requires careful evaluation by highly specialized pathologists. Making the correct diagnosis is key to tailoring treatment to your specific type of cancer. That's why it is important to select a cancer center with a pathology team dedicated to evaluating ovarian cancer of all kinds, like the Division of Women's and Perinatal Pathology at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), affiliated with the Susan F. Smith Center for Women's Cancers.

    Our Pathology Division is one of the few clinical services globally with a team of pathologists and researchers who focus entirely on gynecologic cancers, with thousands of diagnoses each year. The Pathology Division houses the largest team of gynecology specialists in the world; this team discovered that many early cancers develop in the fallopian tubes, not just the ovaries. With this knowledge, they are guiding research teams nationally on how ovarian tumors develop and how they can be prevented.

  • Our pathologists and researchers are skilled at diagnosing common and rare ovarian cancers, including:

    • Epithelial: This is the most common type of ovarian cancer, which starts in the epithelium tissue, the lining on the outside of the ovary or in the fallopian tube. Epithelial ovarian cancer also includes peritoneal cancer and fallopian tube cancer. This type of ovarian cancer is divided into serous (high grade and low grade), mucinous, endometrioid (high grade and low grade), clear cell, transitional, and undifferentiated types. Ovarian carcinosarcoma is another rare type of ovarian cancer that we treat.
    • Germ cell: Germ cell tumors begin in the egg-producing cells. The main subtypes are teratoma, dysgerminoma, endodermal sinus tumor, and choriocarcinoma.
    • Sex cord stromal: These rare tumors grow in the connective tissue that holds the ovary together and makes estrogen and progesterone. Sub-types include granulosa, granulosa-theca, and Sertoli-Leydig cell tumors.
    • Primary peritoneal carcinoma: This is a rare type of ovarian cancer that begins to form in the lining of the pelvis and abdomen and is treated identically to ovarian and fallopian tube cancer.

    If you would like a second opinion...

    Our diagnostic team provides second opinions, including for challenging or difficult cases. We are happy to consult with you, your primary care physician, or other specialists.

    You may want to consider a second opinion:

    • To confirm your diagnosis
    • For an evaluation of an uncommon presentation
    • For details on the type and stage of cancer
    • To better understand your treatment options
    • To learn if you are eligible for clinical trials

    Phone: 877-442-DFCI or 877-442-3324
    Online: Complete the Appointment Request Form
    If you cannot travel to Boston in person, you can take advantage of our Online Second Opinion service

    Tests to diagnose ovarian cancer

    After our doctors carefully review your medical history and your familial risk of developing ovarian cancer, and complete a pelvic exam, they will conduct a combination of biopsies and imaging tests. The results from these tests are reviewed regularly by a dedicated gynecology team of surgeons, medical oncologists, and radiation oncologists. This team will determine the best course of treatment specific to your type of ovarian cancer.

    There is no standard screening test to identify ovarian cancer. Diagnosis of ovarian cancer begins with a pelvic exam with your doctor, which can be helpful in identifying a mass on either side of the uterus. Sometimes a Pap test — a procedure to collect cells from the surface of the cervix and vagina — may also be collected.

    Recommended tests to determine the presence of ovarian cancer

    • Transvaginal ultrasound: a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the vagina, uterus, fallopian tubes, and bladder. The wave echoes form a picture of body tissues called a sonogram.
    • Blood test: a test to measure a substance in the blood called CA-125 (a tumor marker that is often found to be elevated in the blood of women with ovarian cancer). This test is more often used to monitor the progress of treatment than as a screening test, since non-cancer problems can cause it to be elevated.
    • Biopsy: a procedure in which small samples of tissue or cells are removed from the ovary for examination under a microscope. This is done to see if cancer or other abnormal cells are present. The diagnosis of cancer is confirmed only by a biopsy.
      • Fine-needle aspiration (FNA) biopsy or a core biopsy: The removal of tissue or fluid containing ovarian cells, using a thin needle. The biopsy is not of the ovary itself, but is taken from surrounding tissue or fluid.

    Inherited gene mutations

    Approximately up to 20 percent of ovarian, fallopian tube, and peritoneal cancers are caused by inherited gene mutations, such as the BRCA1 and BRCA2 genes and Lynch syndrome. There are genetic tests that can detect these mutated genes, for family members with a high risk of ovarian cancer.

    Detecting a mutated gene does not mean that you will develop cancer, or that cancer is currently present. Learning whether or not you carry a genetic mutation may influence how, how often, and when you and your family begin cancer screenings. In some cases, removing the fallopian tubes and ovaries will significantly reduce the risk of eventually developing ovarian or fallopian tube cancer. In these cases, the tubes and ovaries are carefully examined by pathologists who are experts in detecting early cancers.

    If you or your doctor thinks you are at high risk of developing ovarian cancer, the Cancer Genetics and Prevention Program at Dana-Farber can create a personalized program to accurately estimate your risk and work with you — together with your physicians and nurse practitioners — to lower your risk as much as possible.

    Tests to determine the stage of ovarian cancer

    If ovarian cancer is found after examining ovarian tissue samples, further tests are done to see if the cancer cells have spread within the ovaries or to other parts of the body. The process used to find out if and how far the cancer has spread beyond the uterus is called staging. The following tests and procedures may be used in the staging process:

    • PET/CT scan: A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner or x-ray machine is used to trace and create computerized pictures of the solution inside your body.
    • MRI (Magnetic Resonance Imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. The procedure is similar to having a CT scan except the MRI does not deliver radiation.
    • Pretreatment surgical staging: Surgery is performed to find out if the cancer has spread within the ovaries or to other parts of the body. In some cases, the cancer can be removed at the time of surgery, along with affected organs, or to prevent cancer in organs later on.

    Stages of ovarian cancer

    Information from exams and diagnostic tests is used to determine the extent of the tumor, and whether or not the cancer has spread to the lymph nodes or other tissues. The staging of ovarian cancer is the most important factor in determining a treatment plan.

    The stages of epithelial ovarian cancer are:

    • Stage I indicates cancer in one or both ovaries. Cancer cells may be found on the surface of the ovaries, inside the ovaries, or in fluid or tissue surrounding the abdomen.
    • Stage II means that cancer is found in one or both ovaries, as well as other areas in the pelvis. Cancer cells can be found in the fallopian tubes, uterus, or other tissues in the pelvis, as well as the tissue or fluid surrounding the abdomen.
    • Stage III signifies cancer has spread beyond the ovaries and pelvis, to the abdomen (abdominal wall or small intestines) or nearby lymph nodes. Cancer cells may also be found on the outside of the liver.
    • Stage IV indicates that cancer has spread beyond the ovaries, abdomen, and pelvis to other parts of the body, such as the lungs, the liver, or other tissues. Cancer cells found in the fluid of the lungs are also considered stage IV ovarian cancer.
    Stage IIIB Ovarian Cancer