How is (epithelial) ovarian cancer diagnosed and assessed?

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Initial tests

Initial tests to diagnose ovarian cancer may include:

An examination by a doctor. He or she may feel an enlarged ovary or another suspicious abnormality.
An ultrasound scan. This is a painless test which uses sound waves to create images of structures inside your body. The probe of the scanner may be placed on your abdomen to scan the ovaries. A small probe is also commonly placed inside the vagina to scan the ovaries from this angle in order to obtain more detailed pictures.
A blood test. A sample of blood can detect a protein called CA-125. The level of CA-125 is high in more than 8 in 10 women with advanced ovarian cancer and in about half of women with early ovarian cancer. Other non-cancerous conditions can also cause a high level. This means that this test does not conclusively diagnose or rule out ovarian cancer, but it can be a helpful test. This test is also often used to monitor the effects of treatment for ovarian cancer.

Further tests
You may be advised to have further tests depending on the symptoms that you have and the results of the initial tests. These tests can help to confirm the diagnosis and to 'stage' the disease. The aim of staging is to find out:

How much the tumour has grown and whether it has grown to other nearby structures such as the uterus, bladder or rectum.
Whether the cancer has spread to local lymph glands (nodes).
Whether the cancer has spread to other areas of the body (metastasised).

Stages of ovarian cancer range from 'borderline' and stage 1 (where the cancer is totally confined to an ovary) to stage 4 (where there is extensive spread of the cancer). Tests that are used may include one or more of the following:

CT scan or MRI scan of the lower abdomen. These scans can provide detail of the structure of the internal organs. (See leaflets called 'CT Scan' and 'MRI Scan' for details.)
A chest x-ray
to check if the cancer has spread to your lungs. Blood tests
to assess your general health and to check if the cancer has affected the function of your liver or kidneys. Scans of the bowel or urinary tract. For example, colonoscopy or CT scan. (See leaflets called 'Colonoscopy' and 'CT Scan' for details.) These tests are more likely to be needed if you have symptoms such as constipation or urinary frequency which may indicate the cancer has spread to these areas.
Aspiration of fluid. If your abdomen has swollen with fluid leading to ascites then a sample can be taken. This is done by numbing a small area of skin on the abdomen with local anaesthetic. A fine needle is then inserted through the abdominal wall and some fluid is removed. This fluid can then be looked at under the microscope to look for cancer cells.
Laparoscopy. This is a procedure to look inside your abdomen by using a laparoscope. A laparoscope is like a thin telescope with a light source. It is used to light up and magnify the structures inside the abdomen. A laparoscope is passed into the abdomen through a small incision (cut) in the skin. The ovaries and other internal organs can be seen. Also, biopsies (small samples) can be taken to be looked at under the microscope to detect and confirm cancer cells. (See leaflet called 'Laparoscopy and Laparoscopic Surgery' for details.)

Even with the above tests, the exact stage (extent of spread) may not be known until after an operation to treat the cancer.

Grading of the cancer cells
If a biopsy of the cancer is taken, or cancer cells are found in aspirated fluid, the cells can be assessed. By looking at certain features of the cells under the microscope the cancer can be 'graded'.

Grade 1 (low grade) - the cells look reasonably similar to normal ovarian cells. The cancer cells are said to be 'well differentiated'. The cancer cells tend to grow and multiply quite slowly and are not so 'aggressive'.
Grade 2 - is a middle grade.
Grade 3 - the cells look very abnormal and are said to be 'poorly differentiated'. The cancer cells tend to grow and multiply quite quickly and are more 'aggressive'.

Finding out the stage and grade of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of prognosis (outlook). See leaflet called 'Cancer Staging and Grading' for details.

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