What are the different types of ovarian cancer screenings and tests?

Ovarian cancer is a group of diseases that originates in the ovaries, fallopian tubes or the peritoneum (tissue that lines the abdominal wall and organs). Women have two ovaries located in their lower abdomen, on each side of their pelvis. About the size and shape of an almond, the ovaries produce a woman's eggs and female hormones. Eggs pass from the ovaries through long slender tubes called the fallopian tubes to the uterus. A tissue called the peritoneum covers these structures.

Ovarian cancer can begin in any of these areas, but wherever it begins, treatment for ovarian cancer works best when the cancer is found early. Ovarian cancer is uncommon, but it causes more deaths than any other female reproductive cancer.

There is no screening for ovarian cancer or specific ovarian cancer test. The pap test does not detect ovarian cancer, only cervical cancer. The only way to detect ovarian cancer is by running tests once a woman presents with symptoms consistent with the disease. Unfortunately, ovarian cancer can cause symptoms that are subtle or caused by something other than cancer, so it’s important to recognize and report changes that are not normal for you to your healthcare provider. Signs of ovarian cancer may include:

• Pain, swelling or a heavy feeling in the pelvis (between your hip bones) or lower abdomen
• Pain in the lower abdomen or back
• Pain during sex
• Frequent or sudden urge to urinate
• Abnormal periods or vaginal bleeding after menopause
• Unusual vaginal discharge that is clear, white or tinged with blood
• A lump in the pelvic area
• Weight gain or loss, changes in bowel habits, nausea or loss of appetite

To confirm an ovarian cancer diagnosis, healthcare providers will usually conduct a physical exam, pelvic exam, lab tests, ultrasound and ask about you and your family’s health history. In addition to blood tests to evaluate general health and kidney and liver function, your provider may order a blood test called a CA-125 (cancer antigen 125) that tests for certain tumor markers in the bloodstream. However, an increase in a CA-125 assay may be caused by other conditions, such as endometriosis (when tissue that normally lines the uterus grows outside the uterus), and therefore cannot be used alone or considered a blood test for ovarian cancer.

Some individuals who are in early stages of cancer may have low levels of CA-125 or may not produce high levels of CA-125 with ovarian cancer.  If your provider suspects you may have cancer, they may also check other blood tests that may indicate a tumor and also order genetic testing to look for gene changes that could increase your risk of ovarian cancer. These include human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP), lactate dehydrogenase (LDH) levels and inhibin levels. 

Other commonly used tests for ovarian cancer diagnosis include:

• Ultrasounds, which involve sound waves creating an image to get a first look at internal organs and determine what appears worrisome.
• Computed tomography (CT) scans, which provide a look at many organs, including lymph nodes, to check for evidence of tumors. Unfortunately, CT scans do not show small ovarian tumors well.

Biopsies are the only way to determine if a growth is cancer. In a biopsy, a piece of the tumor is removed and examined in the laboratory. This is usually done during surgical removal of the tumor, but in rare cases, it may be done during a laparoscopy or with a needle biopsy.

• Laparoscopy is a procedure that uses a thin, lighted tube, called a laparoscope, which is inserted through a small surgical cut in the abdomen so a provider can look at the ovaries, other pelvic organs and tissues in the area
• During a needle biopsy, a needle, often guided by ultrasound or CT scan, is placed directly into the tumor through the skin of the abdomen

Still, biopsies outside of surgery are uncommon because of concern that they can actually result in cancerous cells being released.

If you have unusual vaginal bleeding — or any other signs of ovarian cancer for two weeks or longer that are not normal for you — see your healthcare provider right away. Your symptoms may be caused by something other than cancer, and the only way to know is to be checked by your provider.

Clinically reviewed and updated by Julie McDaniel, MSN, RN, CRNI, October 2022.