How Is Ovarian Cancer Diagnosed?

Your health care provider will ask about your symptoms, when they started, how often they occur, and whether they are getting worse. They may also review your personal and family medical history to identify any ovarian cancer risk factors.

Common symptoms may include:

• Bloating
• Pelvic or abdominal pain
• Trouble eating or feeling full quickly
• Frequent or urgent urination
• Changes in bowel habits
• Back pain
• Unusual vaginal bleeding or discharge

Unusual vaginal bleeding should be discussed with a health care provider right away. If other symptoms last for two weeks or longer and are not normal for you, schedule an appointment.

These symptoms can have many causes. A medical evaluation is the only way to determine what may be causing them. The CDC provides additional guidance about ovarian cancer symptoms.

You can use NOCC’s Ovarian Cancer Symptom Diary to track your symptoms and share details with your health care provider. The diary is not a diagnostic test or a substitute for medical care.

Ovarian cancer is evaluated using a combination of exams and tests. An abnormal result on one test does not always mean that cancer is present.

Your health care provider will consider all of your results together and may recommend additional testing. The American Cancer Society provides an overview of the tests used to detect and diagnose ovarian cancer.

During a pelvic exam, a health care provider feels the uterus, ovaries, and nearby organs for changes in size or shape. They may also check for an ovarian mass or fluid in the abdomen, called ascites.

A pelvic exam cannot rule out ovarian cancer. Small tumors may be difficult or impossible to feel, especially during the early stages of the disease.

Imaging tests create pictures of the ovaries and other areas of the body. These tests may help a doctor find a mass, examine its size and appearance, or determine whether cancer may have spread.

Imaging tests used during an ovarian cancer evaluation may include the following.

A transvaginal ultrasound, also called TVUS, uses sound waves to create images of the ovaries, uterus, and nearby tissues. A small ultrasound probe is placed in the vagina.

A TVUS can help show whether an ovarian mass is solid or filled with fluid. It may also provide information about the mass’s size, shape, and internal structure.

However, an ultrasound cannot confirm by itself whether a mass is cancerous.

A CT scan uses X-rays to create detailed, cross-sectional images of the body. It can help show larger ovarian tumors and whether cancer may have spread to lymph nodes, the abdomen, the liver, or other organs.

A CT scan may also be used to guide a needle during a biopsy when that type of biopsy is appropriate.

An MRI uses strong magnets and radio waves instead of X-rays to create detailed images.

It may be used when a doctor needs more information about an ovarian or pelvic mass that was seen on another imaging test.

A PET scan shows areas of increased cell activity in the body. It may be combined with a CT scan to provide more detailed information.

PET scans are not usually the first test used to diagnose ovarian cancer. In some situations, they may help doctors evaluate whether cancer has spread or clarify findings from other imaging tests.

Blood tests can provide information when checking for ovarian cancer, but they cannot tell for sure whether you have ovarian cancer or rule it out on their own.

Your doctor may order blood tests to:

• Check blood cell counts
• Measure kidney and liver function
• Evaluate your overall health
• Measure certain substances in the blood that may provide information
• Help plan additional testing or treatment

Some substances measured in the blood are called tumor markers. Tumor markers can sometimes be higher in people with certain types of ovarian cancer, but they can also be affected by noncancerous conditions. Which blood tests your doctor orders may depend on your age, symptoms, imaging results, and the type of ovarian tumor that may be suspected.

CA-125 is a tumor marker (a protein) that may be found at higher levels in some people with epithelial ovarian, fallopian tube, or primary peritoneal cancer.

A high CA-125 result does not necessarily mean that someone has ovarian cancer. Noncancerous conditions, including endometriosis, uterine fibroids, pelvic inflammatory disease, menstruation, and pregnancy, can also affect CA-125 levels.

Some people with ovarian cancer may also have a normal CA-125 level, especially during the early stages or with certain ovarian cancer subtypes.

For these reasons, CA-125 is not a reliable ovarian cancer screening test for people at average risk. The American Cancer Society explains the uses and limitations of CA-125 testing.

When ovarian cancer is suspected, CA-125 may be used with symptoms, imaging results, and other medical information. After diagnosis, it may also be used to:

• Establish a baseline before treatment
• Measure how the cancer responds to treatment
• Monitor for signs that the cancer may have returned

Other tumor markers may be measured when a less common type of ovarian tumor is suspected.

For example, a doctor may test for:

• Alpha-fetoprotein, or AFP
• Human chorionic gonadotropin, or HCG
• Lactate dehydrogenase, or LDH
• Inhibin
• Estrogen or testosterone

These markers are more commonly associated with certain ovarian germ cell or stromal tumors.

Results must be interpreted with imaging, medical history, and other findings. They do not confirm ovarian cancer on their own.

A diagnosis of ovarian cancer is confirmed when a pathologist examines cells or tissue under a microscope and performs other laboratory tests.

For many ovarian cancers, tissue is collected when the tumor is removed during ovarian cancer surgery.

In other situations, a sample may be collected through:

• A needle biopsy guided by ultrasound or CT imaging
• Laparoscopy, which uses a thin camera inserted through a small incision
• Paracentesis, which removes fluid that has collected in the abdomen

The method used depends on the location of the suspected cancer, whether surgery is appropriate, and the person’s overall health.

Multi-cancer detection tests, also called MCED tests or multi-cancer early detection tests, are newer laboratory tests designed to look for signs of several cancers from one blood or other body-fluid sample.

These tests may look for pieces of DNA, RNA, proteins, or other signals released by cancer cells or produced by the body in response to cancer. Some MCED tests also estimate where in the body a cancer signal may have started.

No MCED test looks for every type of cancer.

An MCED test cannot diagnose ovarian cancer.

If an MCED result suggests that cancer may be present, additional diagnostic testing is needed to determine:

• Whether cancer is actually present
• Where it may have started
• What type of cancer it is
• Whether a biopsy or another procedure is needed

A positive MCED result does not always mean that someone has cancer. A negative result also does not guarantee that cancer is absent.

These tests may detect some cancers or stages more effectively than others. The National Cancer Institute explains how multi-cancer detection tests work and what positive and negative results may mean.

As of July 2026, no MCED test has been cleared or approved by the U.S. Food and Drug Administration. Some are commercially available as laboratory-developed tests, but more research is needed before MCED testing can be recommended for widespread cancer screening.

MCED testing does not replace:

• An evaluation of persistent or unusual symptoms
• Diagnostic imaging or biopsy when ovarian cancer is suspected
• Recommended screening for cancers that have established screening tests
• Follow-up recommended by a health care provider

Researchers are continuing to study whether MCED testing finds cancer early enough to improve outcomes, whether it reduces cancer deaths, and whether its benefits outweigh possible harms.

Possible concerns include false-positive results, false-negative results, unnecessary procedures, anxiety, and cost.

The National Cancer Institute is studying these questions through its Vanguard Study of multi-cancer detection tests.

People considering an MCED test should talk with their health care provider about:

• Their personal and family cancer history
• What cancers the test is designed to detect
• The possibility of false-positive or false-negative results
• What follow-up testing would be needed
• The cost of the test and possible follow-up care
• Whether insurance may cover the testing

For more information, visit the American Cancer Society’s guide to multi-cancer detection tests.

An abnormal blood test, pelvic exam, or imaging result does not always mean that you have ovarian cancer.

Your health care provider will review all of your results and may order additional testing.

If ovarian cancer is suspected, ask for a referral to a gynecologic oncologist. A gynecologic oncologist is a doctor with specialized training in diagnosing, surgically treating, and managing cancers of the female reproductive system.

Whenever possible, meet with a gynecologic oncologist before surgery for a suspicious ovarian mass. This allows the specialist to help plan the procedure and determine which tissues or organs may need to be examined or removed.

The American Cancer Society recommends seeing a gynecologic oncologist when ovarian cancer is suspected.

After a diagnosis is confirmed, your health care team will use your pathology report, imaging results, surgical findings, and other tests to identify the cancer’s:

• Type and subtype
• Grade
• Stage
• Biomarkers or other features that may help guide treatment

The type and stage of ovarian cancer help guide treatment recommendations and provide information about how far the cancer has spread.

People diagnosed with epithelial ovarian, fallopian tube, or primary peritoneal cancer are generally offered genetic counseling and testing for inherited gene mutations, even when they do not have a known family history of cancer. This testing looks for changes you were born with, such as changes in BRCA1 or BRCA2, that may affect your treatment and may provide important information for your family.

Biomarker is a way to gather as much information as possible about the cancer that could affect treatment options. Learn more about the role of genetic and biomarker testing in ovarian cancer treatment.

Additional information and resources are available through:

• Ovarian cancer treatment options
• First steps after a new ovarian cancer diagnosis
• Questions to ask when newly diagnosed with ovarian cancer
• NOCC ovarian cancer educational resources