How is ovarian cancer diagnosed ?
In cases of suspected ovarian cancer, the gynecologist will ask the patient about any symptoms she may be experiencing. They will inquire about the patient’s medical history and potential risk factors for cancer. The gynecologist will also ask whether any family members have had cancer, particularly breast or ovarian cancer.
A thorough physical examination will be performed, including an assessment of the breasts, abdomen, and lymph node areas. A pelvic exam will be conducted to explore the vagina, fallopian tubes, ovaries, bladder, and rectum, aiming to detect any abnormalities in the shape or size of these organs. The doctor will be concerned if a mass is found on one side of the uterus and will also perform a rectal examination.
The gynecologist will order various imaging tests, which are crucial for locating the tumor, determining its size, and identifying whether its contents are solid or fluid.
The primary imaging test is a pelvic ultrasound, a simple procedure using ultrasound waves to detail the size and shape of the ovaries.
The key indicator of cancer is irregularities in the tumor's walls.
Ultrasound can determine whether the ovaries have cysts (fluid-filled cavities) or solid masses. It also helps detect the presence of ascites (fluid in the abdominal cavity).
Additionally, it can identify liver metastases or lymph node involvement. Pelvic ultrasound may be supplemented by Doppler ultrasound to assess tumor vascularization or by transvaginal ultrasound for a more detailed view of the ovaries. Other imaging tests, such as MRI (Magnetic Resonance Imaging), CT scans, and chest X-rays, may also be ordered.
A blood workup will include testing for tumor markers. For patients with a family history of ovarian cancer, testing for BRCA gene mutations will be conducted via a simple blood sample.
If ovarian cancer is confirmed, additional evaluations will be performed before starting treatment. This pre-therapeutic workup will include a thoraco-abdomino-pelvic CT scan and potentially a positron emission tomography (PET) scan.
A more precise evaluation of the spread to the perineum region (the group of muscles that form the pelvic floor) will be conducted. This assessment can be done via laparoscopy, a minimally invasive procedure involving small incisions to insert a camera and instruments into the abdomen for visualizing the peritoneal area and collecting tissue samples for biopsy.
Peritoneal extension can also be evaluated through exploratory laparotomy, which requires a larger incision. This incision can be vertical (typically from below the navel to the pubis) or horizontal above the pubis. The surgeon performing the laparotomy will inform the patient that surgery may follow the examination if necessary.
Laparotomy allows for the visualization of the peritoneal region to identify lesion sites, perform biopsies of any suspicious lesions, and collect ascitic fluid if present. The biopsies and ascitic fluid will be examined under a microscope by a pathologist, who specializes in analyzing organs, tissues, and cells.
The biopsy will determine the exact nature, benign or malignant, of the tumor cells (histological type). Ovarian tumors are relatively common, with 5–10% of women developing an ovarian tumor during their lifetime. Most ovarian tumors are benign.
💡 DID YOU KNOW ?
Most of these benign ovarian tumors originate from epithelial cells that form the outer layer of the ovaries. The most common ovarian tumors are called " ovarian cysts " because most of these tumors contain fluid. The majority of these cysts are referred to as " functional " and arise from the transformation of a follicle or a corpus luteum that should have regressed. The relationship between functional cysts and ovarian cancer is considered unlikely.
A minority of cysts are classified as " borderline " meaning they are on the threshold of malignancy. These cysts must be systematically examined under a microscope, as 1% to 4% of these cysts, initially thought to be benign, are found to be malignant. Each year, these benign tumors result in nearly 45,000 hospitalizations, with more than 32,000 surgeries performed.
The most common histological type of malignant tumors consists of epithelial ovarian tumors (adenocarcinomas), which account for 90% of ovarian cancers.
There are seven histological subtypes of epithelial tumors. Among these, serous epithelial ovarian cancers are the most common, representing approximately 40% of epithelial tumors. These tumors typically affect women aged 40 to 60 years and involve both ovaries in about one-third of cases.
Endometrioid tumors account for 20% of epithelial tumors. These tumors are more commonly found in women aged 50 to 70 years and are thought to develop from endometriosis lesions.
Other subtypes of epithelial cancers, such as mucinous cancers or transitional cell cancers, are rarer. A particular subgroup of epithelial tumors is composed of borderline tumors. These tumors have a slow progression.
Histological analysis also allows the pathologist to determine the tumor stage, which ranges from 1 to 3. The higher the grade, the more the appearance of cancer cells deviates from that of normal cells, and the more aggressive the cancer cells are.
Expert perspective
Grade 1 cancers (well-differentiated cancers) have cells that appear relatively normal and multiply at a slow rate. Grade 3 cancers (poorly differentiated cancers) have highly undifferentiated cells that multiply rapidly. Grade 2 cancers (moderately differentiated cancers) exhibit intermediate characteristics between those of grade 1 and grade 3 cancers.
The combination of findings from the clinical examination, imaging tests, and histological analyses will determine the stage of ovarian cancer.
Expert perspective
The determination of a cancer's stage is primarily of therapeutic importance , as understanding the stage helps to establish the most appropriate treatment for the patient. It also allows for predicting the most likely progression of the disease .
The stage of cancer is determined based on three criteria :
- The first criterion depends on the characteristics of the tumor (T).
- The second criterion is based on the number of lymph nodes involved [N for Node].
- The third criterion relates to the presence of metastases and the number of organs affected by them (M).
These three criteria are used to define the stage of cancer and classify cancers according to an internationally recognized classification system ( TNM classification ).
Stage 1 cancers are tumors confined to the ovary.
Stage 2 cancers are tumors that have spread to the pelvic region (the lower part of the pelvis or pelvic cavity).
Stage 3 cancers are tumors that have invaded the peritoneum [the membrane lining the abdomen, pelvis, and internal organs] and/or lymph nodes.
Stage 4 ovarian cancers are tumors that have spread to form metastases in other organs distant from the pelvis and peritoneum.
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Article updated on Jan 9, 2025
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