How is Ovarian Cancer Diagnosed?

This is the sixth page in the Understanding Ovarian Cancer Guide. This guide was developed by the HealthTree Education Team and was last updated and reviewed on May 20, 2026.

If your doctor thinks you may have ovarian cancer, there are several tests and procedures that can confirm a diagnosis. Diagnosis relies on a combination of your symptoms, a physical examination, imaging, blood tests, and ultimately a tissue sample examined under a microscope.

This page lists all of the different tests that may be needed. Some are used to confirm an ovarian cancer diagnosis. Others are used to learn more about the cancer, such as whether it has spread, and can help guide treatment. Some of these tests may also be used to monitor how well treatment is working. You may not have all of the tests on this list.

Talk to your care team if you have questions about which tests you received and what the results mean for your diagnosis.

Physical examination

Your doctor will typically begin with a thorough medical history and a physical examination, including a pelvic exam to feel for any masses or abnormalities in the pelvic organs.

Imaging tests to diagnose ovarian cancer

Imaging tests create pictures of the inside of the body and are used to look for masses and check whether ovarian cancer has spread:

• Transvaginal ultrasound. A small probe is placed inside the vagina to produce detailed images of the ovaries, fallopian tubes, and uterus. This is often the first imaging test used to evaluate a suspected ovarian mass.
• Computed tomography (CT). A CT scan of the abdomen and pelvis is commonly used to evaluate the extent of disease, including spread to the lymph nodes, peritoneum, liver, or other organs.
• Magnetic resonance imaging (MRI). May be used to better characterize a pelvic mass or evaluate spread when CT findings are unclear.
• Chest X-ray or CT chest. May be used to check whether cancer has spread to the lungs or chest cavity.

Blood tests to diagnose ovarian cancer

Blood tests can support the diagnosis and help monitor ovarian cancer:

• CA-125. A protein that is often elevated in people with epithelial ovarian cancer. CA-125 is used to help evaluate a suspicious mass, monitor response to treatment, and watch for recurrence. CA-125 levels can also be elevated in benign conditions, so it is not used alone to diagnose ovarian cancer.
• HE4 (human epididymis protein 4). Another blood test that, combined with CA-125, can help estimate the likelihood that a pelvic mass is cancer.
• Other tumor markers. For non-epithelial tumors, markers such as alpha-fetoprotein (AFP), beta-hCG, LDH, and inhibin may be measured. These help diagnose germ cell tumors and stromal tumors.
• Complete blood count (CBC) and comprehensive metabolic panel. These tests check overall health and organ function, which can be affected by cancer or its treatment.

Surgery and biopsy

A definitive diagnosis of ovarian cancer almost always requires tissue, which is most often obtained at the time of surgery rather than through a needle biopsy. This is because needle biopsies of ovarian masses carry a risk of spreading cancer cells in the abdomen.

• Staging laparotomy or laparoscopy. A surgeon explores the abdomen and pelvis, removes the suspicious tissue, and takes samples from areas where ovarian cancer commonly spreads. This is both diagnostic and a key part of treatment.
• Paracentesis. If fluid has built up in the abdomen, a condition called ascites, a sample can be removed with a needle and analyzed for cancer cells. This is sometimes used to confirm advanced ovarian cancer when surgery is not the first step.
• Image-guided biopsy. In selected cases, a small tissue sample may be taken from a tumor outside the ovary using image guidance. This is most often considered when surgery is being delayed.

A pathologist then analyzes the tissue sample to confirm cancer, identify the type (epithelial, germ cell, stromal) and subtype, and determine the grade. A pathologist is a doctor who specializes in examining tissue samples.

Biomarker and genetic tests

Biomarker and genetic testing are now an essential part of ovarian cancer care. Results help guide treatment decisions and may have implications for family members:

• BRCA1 and BRCA2 testing. All patients with epithelial ovarian cancer should be offered testing for BRCA1 and BRCA2 mutations, both in the tumor and as a germline test which is a test for inherited mutations. BRCA mutations affect eligibility for PARP inhibitor therapy and have implications for family members.
• Homologous recombination deficiency (HRD) testing. HRD is a broader measure of the cancer’s ability to repair its DNA. HRD-positive tumors, including those with BRCA mutations, often respond well to PARP inhibitors.
• Mismatch repair (MMR) and microsatellite instability (MSI) testing. Identifies tumors associated with Lynch syndrome and may indicate eligibility for certain immunotherapies.
• Multi-gene panel testing. Tests for additional inherited mutations associated with ovarian cancer risk, including RAD51C, RAD51D, BRIP1, PALB2, and Lynch syndrome genes.
• Other tumor profiling. Additional tests may look for mutations in genes such as BRAF, KRAS, or NTRK that can guide use of targeted therapies, particularly for less common subtypes.