Ovarian cancer diagnosis and staging

Your team of ovarian cancer specialists perform targeted tests and procedures to properly diagnose your case.

Medical history and physical exam. Your doctor will take your medical history, and will likely do a pelvic exam to check for an enlarged ovary or signs of fluid in the abdomen. If there is reason to suspect you have ovarian cancer based on your symptoms and/or physical exam, your doctor will order some tests to check further.

Consultation with a specialist. If the results of your pelvic exam or other tests suggest that you have ovarian cancer, you will meet with a gynecologic oncologist, who is specially trained in treating cancers of the female reproductive system. This helps ensure that you get the best kind of surgery for your cancer.

Laparoscopy. A thin, lighted tube through which your doctor can look at your ovaries and other pelvic organs and tissues in the area. Laparoscopy provides a view of organs that can help plan surgery or other treatments, and can help us confirm the stage of the cancer. We can also manipulate small instruments through the laparoscopic incision(s) to perform biopsies.

Colonoscopy.

Biopsy. The only way to determine for certain if a growth is cancer is to remove a piece of it and examine it in the lab. For ovarian cancer, the biopsy is most commonly done by removing the tumor during surgery. In rare cases, a suspected ovarian cancer may be biopsied during a laparoscopy procedure or with a needle placed directly into the tumor through the skin of the abdomen. We would only do this if you cannot have surgery because of an advanced stage of cancer or some other serious medical condition, because there is concern that a biopsy could spread the cancer.

Blood tests. Your doctor will order blood count tests to make sure you have enough red blood cells, white blood cells and platelets, and tests to measure your kidney and liver function as well as your general health. Your doctor will also order a CA-125 test. If you have a high CA-125 level, we would refer you to a gynecologic oncologist.

Genetic counseling and testing. If you have been diagnosed with an epithelial ovarian cancer, we will recommend that you get genetic counseling to help you decide if you should be tested for a mutation in the BRCA1 or BRCA2 gene. Some ovarian cancers are linked to mutations in these or other genes.

Imaging tests

Ultrasound. Often the first test done if a problem with the ovaries is suspected.

Computed tomography (CT) scans. Helps us see if ovarian cancer has spread. We don’t use CT scans to biopsy an ovarian tumor, but we can use it to help biopsy a suspected metastasis in a procedure called a CT-guided needle biopsy.

Barium enema x-ray. Tests to see if the cancer has invaded the colon or rectum.

Magnetic resonance imaging (MRI) scans. MRI scans are not used often to look for ovarian cancer, but they are particularly helpful to examine the brain and spinal cord where cancer could spread.

Chest x-ray. Might be done to determine whether ovarian cancer has metastasized to the lungs.

Positron emission tomography (PET) scan. A test to see if the cancer has spread to lymph nodes or other parts of the body.

PET/CT scan. Some machines can do both a PET and CT scan at the same time.

UCHealth follows the two systems used for staging ovarian cancer—the International Federation of Gynecology and Obstetrics (FIGO) and the American Joint Committee on Cancer (AJCC) staging system.

The system described below is the most recent AJCC system effective January 2018. It is the staging system for ovarian cancer, fallopian tube cancer, and primary peritoneal cancer. Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.

AJCC Stage Stage grouping FIGO Stage Stage description
I T1
N0
M0
I The cancer is only in the ovary (or ovaries) or fallopian tube(s) (T1).

It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

IA T1a
N0
M0
IA The cancer is in one ovary, and the tumor is confined to the inside of the ovary; or the cancer is in one fallopian tube, and is only inside the fallopian tube. There is no cancer on the outer surfaces of the ovary or fallopian tube. No cancer cells are found in the fluid (ascites) or washings from the abdomen and pelvis (T1a).

It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

IB  

T1b
N0
M0

IB The cancer is in both ovaries or fallopian tubes but not on their outer surfaces. No cancer cells are found in the fluid (ascites) or washings from the abdomen and pelvis (T1b). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
IC T1c
N0
M0
IC The cancer is in one or both ovaries or fallopian tubes and any of the following are present:

The tissue (capsule) surrounding the tumor broke during surgery, which could allow cancer cells to leak into the abdomen and pelvis (called surgical spill). This is stage IC1.

Cancer is on the outer surface of at least one of the ovaries or fallopian tubes or the capsule (tissue surrounding the tumor) has ruptured (burst) before surgery (which could allow cancer cells to spill into the abdomen and pelvis). This is stage IC2.

Cancer cells are found in the fluid (ascites) or washings from the abdomen and pelvis. This is stage IC3.

It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

II

 

T2
N0
M0
II The cancer is in one or both ovaries or fallopian tubes and has spread to other organs (such as the uterus, bladder, the sigmoid colon, or the rectum) within the pelvis or there is primary peritoneal cancer (T2). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
IIA T2a
N0
M0
IIA The cancer has spread to or has invaded (grown into) the uterus or the fallopian tubes, or the ovaries. (T2a). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
IIB T2b
N0
M0
IIB The cancer is on the outer surface of or has grown into other nearby pelvic organs such as the bladder, the sigmoid colon, or the rectum (T2b). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
IIIA1 T1 or T2
N1
M0
IIIA1 The cancer is in one or both ovaries or fallopian tubes, or there is primary peritoneal cancer (T1) and it may have spread or grown into nearby organs in the pelvis (T2). It has spread to the retroperitoneal (pelvic and/or para-aortic) lymph nodes only. It has not spread to distant sites (M0).
IIIA2 T3a
N0 or N1
M0
IIIA2 The cancer is in one or both ovaries or fallopian tubes, or there is primary peritoneal cancer and it has spread or grown into organs outside the pelvis. During surgery, no cancer is visible in the abdomen (outside of the pelvis) to the naked eye, but tiny deposits of cancer are found in the lining of the abdomen when it is examined in the lab (T3a).

The cancer might or might not have spread to retroperitoneal lymph nodes (N0 or N1), but it has not spread to distant sites (M0).

IIIB T3b
N0 or N1
M0
IIIB There is cancer in one or both ovaries or fallopian tubes, or there is primary peritoneal cancer and it has spread or grown into organs outside the pelvis. The deposits of cancer are large enough for the surgeon to see, but are no bigger than 2 cm (about 3/4 inch) across. (T3b).

It may or may not have spread to the retroperitoneal lymph nodes (N0 or N1), but it has not spread to the inside of the liver or spleen or to distant sites (M0).

IIIC T3c
N0 or N1
M0
IIIC The cancer is in one or both ovaries or fallopian tubes, or there is primary peritoneal cancer and it has spread or grown into organs outside the pelvis. The deposits of cancer are larger than 2 cm (about 3/4 inch) across and may be on the outside (the capsule) of the liver or spleen (T3c).

It may or may not have spread to the retroperitoneal lymph nodes (N0 or N1), but it has not spread to the inside of the liver or spleen or to distant sites (M0).

IVA Any T
Any N
M1a
IVA Cancer cells are found in the fluid around the lungs (called a malignant pleural effusion) with no other areas of cancer spread such as the liver, spleen, intestine, or lymph nodes outside the abdomen (M1a).
IVB Any T
Any N
M1b
IVB The cancer has spread to the inside of the spleen or liver, to lymph nodes other than the retroperitoneal lymph nodes, and/or to other organs or tissues outside the peritoneal cavity such as the lungs and bones (M1b).

Source: American Cancer Society