Ovarian Cancer: Diagnosis and Treatment

Diagnosis

• A careful history and physical examination may reveal symptoms that may suggest the possibility of ovarian cancer. However, because the symptoms can be vague, the clinical exam may miss the diagnosis in the early stages of disease.
  
  As the cancer advances and the tumor enlarges, the physical examination may reveal a lower abdominal mass and the pelvic examination may reveal a pelvic mass, which should prompt further evaluation.
  
• Blood testing will measure molecules in the blood (CA–125, alpha–fetoprotein, lactate dehydrogenase, human chorionic gonadotropin) that may suggest ovarian cancer. Blood testing is also used to monitor the recurrence of cancer after treatment.
  
• Ultrasound is often used to visualize ovarian tumors, and may distinguish cancer from a benign tumor.
  
• If blood tests and ultrasound raise suspicion for ovarian cancer, most women will then require exploratory surgery to evaluate the tumor more closely and perform a biopsy.
  
  If cancer is found, the surgeon will try to remove as much of the tumor as possible during the exploratory surgery.
  
• CT scan and MRI may be necessary to determine if the cancer has spread beyond the ovaries.

Treatment

• The primary treatment is surgery to remove the tumor. In most cases, both ovaries, the uterus, the fallopian tubes, nearby lymph nodes, and other affected structures are also removed. In advanced disease, chemotherapy is also indicated.
  
  In young women who want to be able to become pregnant, a modified surgical procedure may be possible in which one ovary, one fallopian tube, and the uterus is left in place.