Currently, there is no commercially available screening test for ovarian cancer in the general population. Diagnostic work up of ovarian cancer includes clinical assessment,a physical abdominal/pelvic exam, patient medical history, family history, and may also include ultrasound or CT/MRI imaging. Ovarian cancer can affect one or both ovaries, or the fallopian tubes that connect the ovaries to the uterus and early ovarian cancer often has few or no symptoms, so it can go undetected until a more advanced stage. There are also certain risk factors associated with epithelial ovarian cancer, including a strong family history of ovarian and breast cancer based on genetic mutations. Testing for these mutations may be done to help predict risk for disease, and to develop a prevention or follow-up monitoring strategy.
If an ovarian growth is found, blood tests may be done to measure certain protein markers in the blood. ROMA (Risk Of Ovarian Malignancy Algorithm) can be used to calculate estimated risk of epithelial ovarian cancer in both pre- and postmenopausal women based on CA125 and HE4 test values. Ovarian cancer is diagnosed with histologic analysis and includes immunohistochemistry (IHC) assays of a biopsy or surgical specimen. Tumors of varying subtypes often look similar, making it difficult to distinguish between them so IHC makes it possible to assess for markers associated with particular subtypes, to assist in a differential diagnosis.
Since the stage and grade of ovarian cancer will help guide treatment decisions, it is important that classification be reported as accurately as possible. There are generally four stages of ovarian cancer, referring to the size of a tumor and whether cancer cells have spread to other parts of the body. Tumour grade refers to how abnormal cancer cells look under a microscope, and may be classified as low-grade or high-grade based on a morphological assessment by a pathologist in the laboratory.
