Ovarian Cancer Work-Up: What Each Test Result Decides | IOCI

What Does Each Test Result Change When Ovarian, Tube or Peritoneal Cancer Is Suspected?

Last updated: 07-Oct-2026

Call +91-63590-11009   Send reports before your visit

Each test is a decision, not a box to tick

A work-up for suspected ovarian cancer is not a checklist to finish. Each result opens one path and closes another,.

Ovarian, fallopian tube and primary peritoneal cancer are treated as one disease. So the same tests apply whichever of the three is suspected.

The tests answer five questions, in this order:

The ultrasound decides whether the mass looks like cancer

The first scan is an ultrasound through the vagina and over the belly. It is reported in a standard language (IOTA or O-RADS), so every doctor reads the same description.

Three features raise concern: solid areas inside the mass, finger-like growths on its inner wall (papillary projections), and blood flow inside it.

What it decides: a mass with these features moves on to blood markers and a CT. A mass the ultrasound cannot classify gets an MRI of the pelvis. Otherwise MRI is not a routine test.

CA-125 read with CEA separates ovary from bowel

CA-125 on its own does not make the diagnosis; tissue does. At this stage its real use is in comparison with CEA, a marker that rises more with bowel cancers. CA 19-9 is checked as well.

What it decides: when CA-125 is more than 25 times the CEA value, a start in the ovary is likely. When it is 25 times or less, a colonoscopy and an upper GI endoscopy are done before any treatment. They look for a bowel or stomach cancer that has spread to the ovary.

A bowel cancer follows a different path, so this one comparison can turn the whole plan.

The CT scan maps what an operation can remove

A contrast CT of the chest, abdomen and pelvis maps where the disease is. The radiologist is asked to report on these places, because they decide whether an operation can leave nothing visible behind:

• the omentum, the fatty apron in the belly, and whether it has thickened into a ‘cake’
• the underside of the diaphragm
• the area around the entrance of the liver (porta hepatis)
• the root of the small-bowel mesentery, and whether it is pulled in
• the surface of the bowel
• the lymph nodes at the back of the abdomen

What it decides: whether surgery comes first, or three to four cycles of chemotherapy come first with the operation after. Wide disease on the small-bowel mesentery, at the liver’s entrance or in the upper abdomen points to chemotherapy first.

The CT alone does not settle it. When there is doubt, a diagnostic laparoscopy, a look inside through small cuts, scores the spread (the Fagotti score). The aim is an operation that leaves nothing visible. A planned partial operation is not done.

Tissue proof comes before any chemotherapy

No chemotherapy starts without a tissue diagnosis. When chemotherapy will come first, the tissue comes from a core biopsy taken under scan guidance, or from a diagnostic laparoscopy.

A fine needle aspirate (FNA) is not enough. Nor is fluid from the belly or chest on its own, though that fluid is always sent for testing when it is drawn.

What it decides: when surgery comes first, the operation itself gives the tissue and the stage. Washings are taken from the abdomen before anything is handled. In disease that looks early, biopsies are taken from the lining of the abdomen as well.

That is why the stage on a CT report is provisional. Ovarian cancer is staged at surgery, because small deposits can be too thin for any scan to show.

BRCA and HRD: sent now, used later

BRCA1 and BRCA2 testing, from blood or from the tumour, and HRD testing are sent at the first visit. In India the result takes about three to five weeks.

What it decides: the maintenance medicine given after chemotherapy to keep the disease controlled. The choice changes with whether BRCA is mutated, whether HRD is positive, or neither. When the test is sent only at relapse, the chance to plan maintenance from the start is lost. It is a common, avoidable error.

If BRCA is positive, testing is offered to parents, brothers, sisters and children, and the team follows it until it is done.

Fitness and nutrition decide what the body can take

Blood count, kidney and liver tests, albumin and clotting are checked. A fitness score (ECOG) is recorded.

What it decides: a woman who is fully active is offered the full pathway. If daily activity is limited, the albumin is low, or she is over 75 with other illness, chemotherapy usually comes first, and fitness is checked again before surgery.

Recent heavy weight loss, a low body weight, a low albumin, or eating less than half of usual meals for over a week brings in a dietitian. A pre-surgery exercise and nutrition plan (prehabilitation) starts from the OPD.

Tests that rarely change the plan at this stage

A PET-CT is not part of first staging. It is kept for suspected spread outside the abdomen, or for an unclear recurrence later.

An MRI of the pelvis is used only when the ultrasound cannot describe the mass.

Who puts the results together

No single result decides treatment. Every case is discussed by the tumour board (MDT) before the first treatment. Surgery first or chemotherapy first is a board decision, not one surgeon’s.

Reports can be sent ahead, so the consultation starts with them already read. Treatment is decided at the consultation, after examination.

Book a consultation with Dr Swati Shah at the Gota OPD — +91-63590-11009

Related pages

The operation itself is described on surgery for ovarian cancer in Ahmedabad.

• Surgery for ovarian cancer
• Cytoreductive surgery (CRS) for ovarian cancer
• Chemotherapy for ovarian cancer
• Early, localised ovarian cancer
• Advanced ovarian cancer