If an individual is suspected to have ovarian cancer, detailed investigations are required to establish the diagnosis and stage the disease, which in turn helps in selecting an appropriate treatment option.
Following are some commonly used for ovarian cancer investigations:
Blood tests for tumor marker: Tumor markers are generally proteins or other substances that are produced by both normal cells and cancer cells.
However, in case of cancer, the level of these markers rises in blood, which can be detected by certain laboratory tests.
Level of cancer antigen (CA)-125 has been reported to be elevated in patients with ovarian cancer. However, CA-125 is considered as a less specific tumor marker because it’s level may also get elevated (false positive results) in some other non-cancerous conditions like endometriosis, pelvic inﬂammatory disease (PID), liver cirrhosis, peritonitis, pleuritis, pancreatitis, or in other cancers like breast cancer, lung cancer, or leiomyomas (smooth muscle tumors), etc.
Also, mucinous ovarian cancer is not always associated with an elevated level of CA-125 (false negative results). Thus, this marker is generally used for assessing the prognosis and the progression/recurrence of the disease in patients with ovarian cancer.
Germ cell ovarian cancers may be associated with an elevated level of beta-human chorionic gonadotropin (beta-HCG), alpha-fetoprotein (AFP), and/or lactate dehydrogenase (LDH), depending upon the subtype. While sex cord-stromal tumors may cause an elevated blood level of inhibin.
- Transvaginal Ultrasound (TVUS): In this technique, a vaginal probe is used, which directs high-frequency sound waves towards the internal body parts to be examined. The sound waves are reflected off the internal structures depending upon their ability to reflect these waves and collected by a special detector to produce a real-time image of the internal tissues on a computer screen.
This helps the doctor to examine the ovaries, fallopian tubes, uterus and other nearby structures for any abnormality. It can distinguish between solid tumors (appear as a solid mass) and fluid-filled cysts.
- Biopsy: Biopsy sample(s) for ovarian cancer are generally collected during surgery, but can be collected under imaging guidance from the affected area(s) when surgery is not possible due to advanced disease, or poor health condition of the patient.
When subjected to various laboratory tests, these samples provide information about the type of cancer, grade of cancer, presence of specific defective genes or proteins, etc.
- Imaging Tests: These tests are generally employed after the establishment of the pathological diagnosis. They help to diagnose the extent of locoregional invasion and spread of disease to the distant organs.
Alternatively, these tests are employed after treatment to evaluate the treatment efficacy and to detect any signs of disease progression/recurrence.
Computed tomography (CT) scan: In this technique, detailed cross-sectional images of body organs are generated using x-rays, with or without oral/intravenous contrast (like barium and certain dyes).
It can help diagnose the spread of disease to nearby/distant lymph nodes and other organs, and may also be used to guide a biopsy needle into the affected area.
Positron emission tomography (PET) scan: This technique uses a radioactive substance (fluorodeoxyglucose [FDG], etc) that is given via intravenous injection prior to the procedure.
Cancer cells absorb larger amounts of the radioactive substance than normal cells. The areas of higher radioactivity indicate cancerous tissue on the PET scan. Thus, this technique can diagnose unsuspected spread of disease to distant body parts. It is usually combined with CT scan (PET/CT).
Magnetic resonance imaging (MRI) scan: This technique provides detailed images of tissues inside the body using radio waves, strong magnetic field, and gadolinium contrast. It can accurately diagnose the extent of invasion and spread of disease to nearby/distant body parts.
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Watch the video below where Cancerbro explains various types of Ovary Cancers.
CancerBro, but I am just 18 years old and have been diagnosed with ovarian cancer. I too have been diagnosed at the age of 32 years.
Yes, rarely it may present at a younger age. For this, you first have to know the different sub-types of ovarian cancer.
The most common sub-type of the ovarian cancer is epithelial, which constitutes for more than 90% of the cases. It presents at an advance age, mostly after 50 years.
It has various sub-types, the most common being serous, followed by mucinous. Endometrioid and clear cell are seen rarely.
The less commonly seen are sex cord stromal tumors and germ cell tumors, which together constitute for less than 10% of the total cases of ovarian cancer.
Sex cord stromal tumor may be granulosa cell tumor, which is mostly seen at a later age and sertoli-leydig cell tumor, which is mostly seen at a younger age. Rare sub-type is thecoma fibroma.
Next comes the germ cell tumor, which is more commonly seen in adolescent population. It has various sub-types such as teratoma, dysgerminoma, endodermal sinus or yolk sac tumors, choriocarcinoma and embryonal carcinoma.
So most cases of ovarian cancer are seen at an old age, but germ cell tumor and certain sub types of sex cord stromal tumors and epithelial ovarian tumors may be seen in younger age.
Video Explaining Ovarian Cancer Investigations:
CancerBro, what are the ovary cancer investigations required if suspected cancer?
To confirm the diagnosis of ovary cancer, we have to do some scans and blood tests.
The first step is to do transabdominao or transvaginal ultrasound, to look for the ovary mass and the rest of the pelvic structures.
CT scan of abdomen and pelvis or PET CT scan may be done if required.
Next step is to do blood tests, which will depend upon the sub-type of ovary cancer, as we have discussed previously.
CA-125 is the tumor marker for epithelial ovary cancer, which is elevated most commonly.
But CA-125 testing has some limitations. It may be false negative in some cases, that is negative when there is cancer. This could be seen in subtypes other than epithelial ovary cancer.
Even in some cases of an early-stage disease, it could be a false negative. Also, in the mucinous subtype of epithelial ovary cancer, it may be negative, and CA 19.9 or CEA may be elevated.
CA-125 may also be false positive, that is elevated in the absence of ovary cancer. Other cancers in which it may be false positive are breast, lung and GI cancer.
The non-cancerous conditions in which it may be false positive are PID, endometriosis, pregnancy, cirrhosis, peritonitis, pleuritis and pancreatitis.
The tumor marker for germ cell tumor is AFP, beta HCG, and LDH. Different sub-types of germ cell tumors have different combinations of this tumor marker elevated.
Most commonly elevated in dysgerminoma is LDH, and beta HCG may also be elevated in some cases, but AFP is never elevated in dysgerminoma.
In choriocarcinoma, beta HCG is very high and LDH may also be elevated.
In endodermal sinus or yolk sack tumors, AFP is high and LDH may also be elevated.
Inhibin A and inhibin B are the tumor markers for sex cord-stromal tumors, mainly granulosa cell subtype.