Ovarian Cancer: The Critical Role of Testing

By Dr. Hemant B. Tongaonkar in Nanavati Max Institute of Cancer Care , Nanavati Max Institute of Advanced Orthopaedics, Spine & Joint Care , Gynaecological Oncology Program

Jul 01 , 2023 | 5 min read

Ovarian cancer remains one of the most challenging malignancies to detect early due to its subtle, non-specific symptoms. However, a comprehensive understanding of epithelial, stromal, and germ cell risk factors, early clinical warning signs, and the multi-step diagnostic testing methods can significantly improve patient outcomes.

Overview: Why Early Detection Matters

Ovarian cancer often goes undiagnosed until its later stages, which makes early-stage detection critical. According to the American Cancer Society (2026) estimates, the five-year survival rate is approximately 94% when ovarian cancer is detected at a localized stage (Stage I). This highlights the importance of symptom awareness, regular check-ups, and proactive biomarker testing for at-risk individuals.

The Critical Role of Ovarian Cancer Screening & Testing

While no universal ovarian cancer screening test exists for women at average risk, the following methods are commonly used to evaluate symptomatic patients or those with a high genetic predisposition:

a) Pelvic Examinations
A routine pelvic exam involves the doctor feeling (palpating) the ovaries and uterus for any abnormal growths (adnexal masses) or irregularities. While this method can detect some large cancers, it is not effective in identifying small, early-stage tumors.
b) Transvaginal Ultrasounds (TVUS)
TVUS uses sound waves to create detailed images of the ovaries and surrounding pelvic tissues. It is often the first-line imaging test to distinguish between a fluid-filled cyst and a solid cancerous (malignant) mass. Although it can detect abnormalities, it cannot provide a definitive diagnosis without a tissue sample (histopathological confirmation).
c) CA-125 Blood Test
The CA-125 test measures the level of a protein often elevated in women with epithelial ovarian cancer. However, high CA-125 levels can also be caused by benign conditions like endometriosis or pelvic inflammatory disease, making this test a helpful but non-definitive biomarker.
d) Genetic Testing for Ovarian Cancer
Genetic testing identifies inherited (germline) mutations in the BRCA1 and BRCA2 genes that drastically increase the risk of ovarian and breast cancers. Individuals with a family history should consider genetic counseling to discuss the surgical removal of ovaries and tubes (risk-reducing salpingo-oophorectomy) and the development of prevention strategies.

Read More about the Symptoms of Ovarian Cancer

How Doctors Confirm Ovarian Cancer: The Diagnostic Journey

Because current ovarian cancer screening is not definitive, a precise diagnostic flow is required once an abnormality is detected. This journey typically moves from non-invasive imaging to surgical intervention.

1. Advanced Imaging: CT, MRI, and PET Scans

If a TVUS shows a suspicious mass, oncologists order a Contrast-Enhanced CT (CECT) of the abdomen and pelvis. CT scans are the gold standard for checking if the tumor can be surgically removed (resectability) and identifying if the cancer has spread to the fatty lining of the abdomen (omentum) or lymph nodes. MRI is reserved for evaluating complex masses, while PET/CT scans help identify cancer spread (metastasis) in recurring cases.

2. The Role of Surgical Biopsy

Unlike other cancers, a needle biopsy is often avoided in ovarian cancer to prevent "seeding" (leaking cancer cells into the abdomen). Instead, a definitive diagnosis is usually made through minimally invasive laparoscopy or open surgery (laparotomy). During this procedure, surgeons remove the suspicious tissue for immediate analysis (frozen section) by a pathologist.

Know More about Ovarian Cancer in Young Females

Ovarian Cancer Staging: The FIGO System

Once confirmed, the cancer is assigned a stage using the FIGO (International Federation of Gynecology and Obstetrics) system. This determines the strength of the treatment plan.

Stage	Extent of Spread	5-Year Relative Survival Rate (2026)
Stage I	Confined to one or both ovaries/fallopian tubes.	>90%
Stage II	Spread to pelvic organs (uterus, bladder, rectum).	~70%
Stage III	Spread to the abdominal lining (peritoneum) or lymph nodes.	~40-50%
Stage IV	Distant spread (lungs, liver, or inside the spleen).	~20%

The Importance of Regular Check-Ups

Routine health check-ups play a critical role in monitoring for ovarian cancer. Women with risk factors should discuss personalized ovarian cancer screening options with their doctors. A combination of regular pelvic exams, transvaginal ultrasounds, and CA-125 testing may improve detection frequency in high-risk populations.

Conclusion

Ovarian cancer is a formidable disease, but clinical awareness and early intervention can significantly improve outcomes. By recognizing non-specific symptoms, understanding your genetic risk factors, and consulting a gynecologic oncologist about testing options, you can take control of your health.

Disclaimer: The information in this blog is for educational purposes only and does not substitute professional medical advice. Always consult a qualified oncologist for diagnosis and treatment plans.

Learn More about the Types of Cancer in Women

Frequently Asked Questions

1. How can ovarian cancer be detected early?

There is currently no standard ovarian cancer screening for women with no symptoms. Ovarian cancer is detected early, primarily when symptoms like persistent bloating are reported promptly, leading to a combination of imaging and blood tests.

2. What are the most common symptoms of ovarian cancer?

Common symptoms include persistent bloating, pelvic or abdominal pain, feeling full quickly (early satiety), and frequent urination. If these symptoms occur more than 12 times a month, consult a gynecologist or oncologist immediately.

3. Are CA-125 tests reliable for ovarian cancer detection?

CA-125 tests are helpful but not definitive. Normal levels are typically below 35 U/mL, but elevated levels may indicate ovarian cancer or benign conditions like endometriosis. In 2026, they remain a secondary tool rather than a primary screening method.

4. How often should I get tested if I have a family history of ovarian cancer?

If you carry a BRCA1/2 mutation, experts often recommend CA-125 and TVUS every 6 months starting at age 30-35. Please note that the decision for preventive surgery involves significant health and financial considerations, and you should consult with a multidisciplinary team.

5. What are the chances of ovarian cancer being hereditary?

Around 20-25% of ovarian cancers are linked to inherited genetic mutations, primarily BRCA1 and BRCA2. Current 2026 guidelines recommend that ALL women diagnosed with epithelial ovarian cancer receive genetic testing.

6. What causes ovarian cancer?

Ovarian cancer occurs when abnormal cells in the ovaries grow and multiply uncontrollably. Beyond genetics, risk factors include older age, obesity, and never giving birth (nulliparity).

7. What are the main treatments for ovarian cancer?

The primary treatments include surgical removal of the tumor (cytoreductive surgery), platinum-based chemotherapy, and targeted therapies like PARP inhibitors.

8. Should I see a gynecologist or oncologist first?

If you suspect ovarian cancer, starting with a gynecologist is recommended. However, research shows that patients have significantly better survival outcomes when their initial surgery is performed by a specialized gynecologic oncologist.