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Diagnosis If ovarian cancer is suspected due to physical symptoms or physical exam then there are specific tests that will help with the diagnosis. Your doctor may recommend radiographic studies such as ultrasound, x-ray, abdominal and pelvic CT scan, or MRI. Laboratory blood tests commonly include a CA-125 and a chemistry profile looking at liver function. Other minor surgical procedures that may be done to gather more diagnostic information include removal of fluid from the abdominal cavity (called paracentesis) or fluid from around the lungs (called thoracentesis) using special needles. The fluid is examined under the microscope for cancer cells. These minor procedures can confirm the presence of cancer, but cannot make the diagnosis of ovarian cancer with certainty. Ovarian cancer is diagnosed at the time of surgery. Actual tissue from the ovarian tumor itself is the only absolute method to confirm a diagnosis of ovarian cancer. Biopsies are taken from the tumor tissue and sent to the pathologist for examination under the microscope. Laparotomy (a surgical procedure which involves opening the abdominal cavity for examination) is the most certain way of diagnosing ovarian cancer and assessing if the cancer has spread to surrounding organs(metastasis).. During surgery a section of the tumor will be given to a pathologist for an immediate review. If the preliminary report is ovarian cancer, the surgeon will perform a more extensive surgery to determine the stage of the cancer. To prepare for a major surgical procedure, a chest x-ray will be included in the preoperative evaluation to determine if there is any cancer spread to the lungs and to assure that the lungs are healthy for surgery. If there are any gastrointestinal symptoms or suspicion of cancer involvement, special x-rays of the bowel (barium enema or colonoscopy) may be indicated, as well as a bowel preparation (enemas and medication) to cleanse the colon. Women who have not had a recent mammogram may have one performed at this time and an ECG (electrocadiogram--a test that measures the electrical conduction of the heart) if over age 45. Routine preoperative laboratory tests include blood serum chemistries, liver and kidney function tests, a CBC (complete blood count) blood typing for potential transfusions, urinalysis, a baseline CA-125 (if not already done) and a pregnancy test, if appropriate. Additional tests or special medications may be ordered depending on the individual patients' age and general health. Staging The stage of a cancer indicates the extent of disease or how widespread it is, i.e. is the cancer confined to the organ of origin or has it spread to the other nearby areas, lymph nodes or distant organs. Staging of ovarian cancer is a highly skilled surgical operation and is performed during the primary (initial) surgery to remove as much of the cancer as possible. Surgical staging is of critical importance in the management of the disease since both treatment and prognosis (a prediction about the likely outcome or course of the disease) strongly depend on an accurate stage. It is based on an understanding of the patterns of disease spread and must be performed in a systematic and thorough manner. A gynecologic oncologist is a gynecological surgeon specifically trained to perform these types of operations. It is recommended that a gynecological oncologist be consulted prior to any ovarian cancer surgery. 
The staging system for ovarian cancer was developed by the International Federation of Gynecology and Obstetrics (FIGO, 1998) and is used uniformly in all developed countries.
Although there are subcategories to each stage, the basic four stages of ovarian cancer are:
Grading The grade of a cancer (the histologic grade) measures how abnormal or malignant its' cells look under the microscope. Tumors are graded on a scale of 0 to 3, with grade 0 tumors representing non-invasive tumors of low malignant potential (LMP), also called borderline tumors. Grade 1 tumors look most like normal tissue (called well differentiated), grade 2 look somewhat like normal tissue (called moderately well differentiated) and grade 3 tumors appear very abnormal (called poorly differentiated or undifferentiated). Grade 1 tumors have the best prognosis, while grade 3 tumors are the most serious.. The histologic grade seems to correlate roughly with the biological aggressiveness of the tumor. Prognostic Factors The prognosis, or predicted likely outcome of the disease (chance of recovery or recurrence), of ovarian cancer depends on a number of factors. Of primary importance and significance is the stage of disease as well as the amount or volume of residual disease (the amount of cancer remaining in the abdomen or pelvis after primary surgery). Other factors that influence survival are the histologic cell type, the cancer grade, age, performance status, and the volume of ascites (fluid in the abdomen), if present. Favorable/low risk prognostic factors include early or limited stage, low histologic grade, non-clear cell histology, none to minimal residual disease (less than one centimeter,1cm), younger age, and a good performance status. Patterns of Metastasis When cancer spreads to other organs or areas of the body, it is called metastasis. In ovarian cancer, metastasis can occur in four ways.
Common areas for ovarian cancer spread include the lining of the abdomen or pelvis (peritoneum), organs of the abdomen such as the bowel, bladder, uterus, liver and lungs. Recurrent Ovarian Cancer If ovarian cancer returns more than 6 months after the completion of therapy, it is called a "persistent ovarian cancer," and its original stage still applies. If the cancer reoccurs within 6 months after the completion of therapy it may be referred to as “persistant ovarian cancer.”  This content is reviewed regularly. Last Updated 10/21/2008
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