Ovarian Cancer Early Detection, Diagnosis, and Staging

Why is it hard to find ovarian cancer early? Ovarian cancer is hard to find early because it often does not cause symptoms until the cancer is advanced. Even regular pelvic exams usually can’t detect small tumors in the ovaries. Unlike for some other cancers, there’s no screening test that works well enough to find ovarian cancer early in most people. Researchers are still working to develop better ways to find it sooner. What you can do to help find ovarian cancer early Although there are no sure ways to find ovarian cancer early, it can help to be aware of symptoms and see your doctor regularly. What to know about ovarian cancer screening Screening tests and exams are used to detect a disease in people who don’t have any symptoms. (For example, a mammogram can often detect breast cancer in its earliest stage, even before a doctor can feel the cancer.) Limitations of current screening tests for ovarian cancer There has been a lot of research to develop a screening test for ovarian cancer, but there hasn’t been much success so far. The 2 tests used most often (in addition to a complete pelvic exam) to screen for ovarian cancer are transvaginal ultrasound (TVUS) and the CA-125 blood test. TVUS (transvaginal ultrasound) uses sound waves to look at the uterus, fallopian tubes, and ovaries by putting an ultrasound wand into the vagina. It can help find a mass (tumor) in the ovary, but it can't tell whether it’s cancer or benign. In fact, most masses found during screening are not cancer. The CA-125 blood test measures a protein in the blood that’s often high in women with ovarian cancer. It can help track how well treatment is working if you have ovarian cancer, but it’s not a reliable screening test. Many common benign conditions such as endometriosis and pelvic inflammatory disease can also raise CA-125 levels. And not all ovarian cancers cause a high CA-125 level. If your CA-125 level is high and you don’t have a cancer diagnosis, your doctor might repeat the test or suggest a transvaginal ultrasound test. Should I be screened for ovarian cancer? Screening tests for germ cell tumors/stromal tumors There are no recommended screening tests for germ cell tumors or stromal tumors. Some germ cell cancers release proteins such as human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) into the blood. For women who have been treated for these tumors, doctors can use blood tests for these markers to see how well treatment has worked or to see whether the cancer is coming back. Future screening tests for ovarian cancer Although there are no reliable screening tests for ovarian cancer yet, researchers are still looking for better tests. One method being researched involves looking at the pattern of proteins in the blood (called proteomics) to find ovarian cancer early. Hopefully, improvements in screening tests will eventually lead to fewer deaths from ovarian cancer. Genetic counseling and testing if you have ovarian cancer If you have been diagnosed with an epithelial ovarian cancer, your doctor will likely recommend genetic counseling and genetic testing for certain inherited gene changes, even if you do not have a family history of cancer. The most common mutations found are in the BRCA1 and BRCA2 genes, but some ovarian cancers are linked to mutations in other genes, such as ATM, BRIP1, RAD51C/RAD51D, MSH2, MLH1, MSH6, or PMS6. Genetic testing to look for inherited mutations can be helpful in several ways If you have a gene mutation, you may be more likely to get other types of cancer as well. There may be ways lower your risk of these cancers, as well as having tests to find them early. If you have a gene mutation, your family members (blood relatives) might also have it. They can decide if they want to be tested to learn more about their own cancer risk. If you have a BRCA1 or BRCA2 mutation, at some point you might benefit from targeted drugs called PARP inhibitors. Even if you do not have any of the gene mutations listed above, your tumor might be tested for some of these abnormal genes because it might give you more options for treatment. Be cautious about home-based genetic tests, including those approved by the FDA. These tests have limitations. For example one approved test for BRCA1 and BRCA2 gene mutations only checks for a few mutations, even though there are more than 1,000 known BRCA mutations. This means the test could miss many mutations linked to cancer risk. A genetic counselor or other qualified medical professional can help you understand the risks, benefits, and possible limits of what genetic testing can tell you. This can help you decide if testing is right for you, and which testing is best. To learn more about genetic testing, see Should I Get Genetic Testing for Cancer Risk? Tests for gene or protein changes in ovarian cancer In some ovarian cancers, doctors might test the cancer cells for specific gene or protein changes to see if certain targeted or immunotherapy drugs might help treat the cancer. These tests can be done on a tumor sample taken during a biopsy or surgery.