If your CA-125 test comes back high, you'll need an appointment with your doctor to discuss the results. If you haven't had a transvaginal ultrasound yet, that will typically be the next step. A transvaginal ultrasound is just an ultrasound performed using a small wand that is gently inserted into the vagina (this is the same type of ultrasound done in early pregnancy, before a baby is big enough to be seen with the traditional "belly" ultrasound).
In many cases, CA-125 testing produces false positives, and your ultrasound may show that there is nothing to worry about. Sometimes, a computed tomography (CT) scan may be done in addition to a transvaginal ultrasound.
If your ultrasound or CT scan shows a tumor or anything else your doctor is concerned about, usually a biopsy is the next step. A biopsy is the only way to know for sure if a tumor is cancerous or not. Typically, this is done surgically, giving the surgeon the option to completely remove the ovary if it looks cancerous. This helps prevent the tumor from leaking cancer cells to the rest of the body during the biopsy. The biopsied tissue is then sent to a lab, and a pathologist will determine if it is cancerous or not.
Accidental Ovarian Cancer Detection
Because the early symptoms of ovarian cancer are so vague, sometimes the cancer is detected by accident, often during an ultrasound for a different reason, such as during a pregnancy. Ovarian cancer is sometimes discovered during a cesarean section (C-section) as well. While receiving a cancer diagnosis during pregnancy or right after having your baby may seem unfathomably cruel and unfair, the good news is that, in many cases, the cancers are caught in the very early stages and are treated quite successfully. Typically, the pregnancy continues as normal and results in a healthy baby.
Ovarian cancer is sometimes also detected accidentally during other abdominal surgeries or during CT scans or magnetic resonance imaging (MRIs) performed for other reasons.
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Dobashi M, Isonishi S, Morikawa A, et al. Ovarian cancer complicated by pregnancy: Analysis of 10 cases. Oncol Lett 2012;3(3):577-580.
Memorial Sloan-Ketterling Cancer Center. Screening guidelines. Ovarian cancer (n.d.). Memorial Sloan-Ketterling Cancer Center Web site. Available at: http://www.mskcc.org/cancer-care/screening-guidelines/screening-guidelines-ovarian. Accessed August 27, 2013.
American Cancer Society. How is ovarian cancer diagnosed (March 21, 2013). American Cancer Society Web site. Available at: http://www.cancer.org/cancer/ovariancancer/detailedguide/ovarian-cancer-diagnosis. Accessed August 27, 2013.
Lu KH, Skates S, Hernandez MA, et al. A 2-stage ovarian cancer screening strategy using the risk of ovarian cancer algorithm (ROCA) identifies early-stage incident cancers and demonstrates high positive predictive value [published online ahead of print, August 26, 2013]. Cancer.
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