Diagnosing ovarian cancer: from examination to decision-making

Why there is no routine screening

The available tests, such as CA-125 blood tests and pelvic ultrasounds, are not precise enough for large-scale screening. When applied to a population without symptoms, they generate too many false positives—abnormal results in women who do not have cancer—leading to unnecessary investigations and anxiety.

A large-scale study of 78,000 women, cited by Vidal and the ARC Foundation, showed that mortality rates were identical with or without routine screening. It is on this basis that health authorities have not adopted organized screening for this cancer.

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From imaging to biopsy: the diagnostic assessment steps

The assessment follows a progressive logic. Each examination refines the suspicion and prepares for the next decision.

1. Pelvic ultrasound : the first examination performed when an ovarian mass is suspected. It allows for visualization of the ovaries and assessment of the lesion's characteristics (size, content, vascularization). However, it is not sufficient to distinguish between a benign and a malignant tumor. ‍
2. Abdominopelvic MRI is prescribed when an ultrasound reveals an abnormality. It provides a more detailed analysis of the lesion, its local extent, and its relationship with neighboring organs. ‍
3. Thoraco-abdominopelvic CT scan : performed to map the extent of the disease (peritoneum, lymph nodes, distant organs). It is essential for the staging assessment before any therapeutic decision is made. ‍
4. Exploratory laparoscopy and biopsy : the only examination that confirms the diagnosis with certainty. A surgeon directly visualizes the lesions, objectively quantifies them (scores), takes tissue samples, and sends them to a pathologist. It is the microscopic analysis of these cells that establishes the histological type, the grade, and confirms the malignant nature of the tumor.

The CA-125 tumor marker (a protein whose blood level may be elevated in the presence of ovarian cancer) is measured alongside these examinations. Its level can also be elevated in other situations, such as endometriosis or inflammation. It is always interpreted in combination with imaging results, never in isolation.

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Stage, grade, histology: what these details mean for your care

Once the diagnosis is made, three parameters determine the treatment strategy: the stage, the grade , and the histological type.

The stage (FIGO classification) describes the extent of the disease at the time of diagnosis:

• Stage I : cancer limited to the ovaries or fallopian tubes, with no spread beyond ‍
• Stage II : spread to other pelvic organs (uterus, cervix, bladder, rectum) ‍
• Stage III : spread to the abdominal cavity (peritoneum) and/or retroperitoneal lymph nodes; this is the most common stage at diagnosis ‍
• Stage IV : distant metastases (liver parenchyma, lungs, extra-abdominal lymph nodes)

The grade (1, 2, or 3) assesses the degree of differentiation of the tumor cells. A grade 3 indicates poorly differentiated cells with more aggressive behavior. The majority of serous carcinomas, the most frequent form, are high-grade.

The histological type specifies the cellular origin of the tumor (serous, endometrioid, clear cell, mucinous carcinoma, etc.). Each subtype behaves differently and responds uniquely to available treatments.

The combination of these three factors, supplemented by the genetic profile (BRCA, HRD) and the patient's general health, guides the therapeutic strategy defined during a multidisciplinary team meeting (MDT). If the report you received mentions a specific stage or grade and you wish to understand its implications for your treatment, a second opinion allows you to obtain an analysis of your complete file from a gynecologic oncologist. Not a generic overview: a look at your specific situation.

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The BRCA mutation: a result that also involves the family

Testing for BRCA1 and BRCA2 gene mutations is recommended as soon as an ovarian cancer diagnosis is confirmed. These genes play a role in DNA repair: when they are mutated, cancer cells exhibit a specific deficiency known as HRD (homologous recombination deficiency), which makes them sensitive to a class of targeted drugs called PARP inhibitors. A positive BRCA result can therefore provide access to these therapies as maintenance treatment.

For the patient's loved ones, this result indicates an increased risk that warrants evaluation. This is why an oncogenetic consultation is systematically offered. It provides an opportunity to explain the meaning of the result, its implications for treatment, and to organize screening for family members who wish to undergo it.

This result can be difficult to process, both for the patient and their loved ones. An oncogenetic consultation is the appropriate setting to discuss it with a professional trained in this type of support.

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