What tests are used to diagnose and stage ovarian cancer? Expert Dr. Kevin Elias explains how imaging, blood tests, biopsies, and surgical evaluation work together to determine the disease stage and help guide ovarian cancer treatment decisions.
Dr. Kevin Elias is a gynecologic oncologist and serves as the Lilli and Seth Harris Endowed Chair for Ovarian Cancer Research at the Cleveland Clinic, where he holds academic appointments in Gynecologic Oncology, Obstetrics and Gynecology, and Biomedical Engineering. Learn more about Dr. Elias.
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Transcript
Katherine Banwell:
So, before a treatment is decided on, it’s important to know more about a patient’s individual diagnosis. Let’s start with how is ovarian cancer staged?
Dr. Kevin Elias:
Absolutely. Ovarian cancer is staged based on whether it’s confined to the fallopian tube in the ovary, or whether it’s involving other structures in the pelvis or distantly elsewhere in the body. Most ovarian cancers, when they’re diagnosed, will be stage III or stage IV, meaning that there’s cancer that has spread beyond just the ovary and immediately localized structures, but to other sites within the abdominal cavity or elsewhere in the body.
Katherine Banwell:
And why are you saying it’s usually only stage III and IV?
Dr. Kevin Elias:
So, unfortunately, most women with ovarian cancer don’t become symptomatic to the point where they’re diagnosed until they already have disease that’s spread to other parts of the body.
Katherine Banwell:
Yeah. What testing should be done following an ovarian cancer diagnosis?
Dr. Kevin Elias:
So, importantly, ovarian cancer is diagnosed with histology, meaning we need to have tissue under the microscope to make a diagnosis of ovarian cancer. At this time, there’s no blood test or radiologic imaging test, which can be diagnostic of ovarian cancer until we have a biopsy. So, the most important thing is having the tissue looked at, preferably by a gynecologic pathologist with an expertise in ovarian cancer.
At the time that the tissue was looked at, we would want to compare it with blood markers, particularly a CA-125 test or CA-125 test, which is a protein that helps guide treatment for women who’ve been diagnosed with ovarian cancer. And then, we would want the pathologist to start to look at particular markers, which I imagine we’ll talk about in a minute, that might be expressed by a tumor, which might help guide individualized therapy.
Katherine Banwell:
When you refer to getting a tissue from a patient, does that involve a biopsy?
Dr. Kevin Elias:
It depends on where the disease is distributed.
So, for patients who are not going to be going directly to surgery, a biopsy would be preferable. And that can be done either by an interventional radiologist through a needle biopsy, or it can be done by a surgeon using a small surgical procedure called a laparoscopy, or we look in with a camera and use that to direct the biopsy directly. If there’s not evidence of cancer outside of the ovary, or it seems like the amount of disease that’s there would be amenable to complete removal of it surgically, it’s preferable to go directly to surgery rather than to do a biopsy first.