Ovarian Cancer Ultrasound: Your Guide to Detection and Understanding

An ultrasound plays an important role in the detection and diagnosis of ovarian cancer. What should you expect if your doctor recommends one? Let’s dive into everything you need to know about the ovarian cancer ultrasound, an essential diagnostic tool.

Can an Ultrasound Detect Ovarian Cancer?

The short answer? Sometimes. But it’s not that simple.

Ultrasound serves as one of the primary tools doctors use when investigating potential ovarian cancer, but it’s not perfect. These scans can identify abnormal masses or growths on the ovaries, but they cannot definitively determine whether a mass is cancerous or benign by themselves.

Ultrasounds can raise suspicions and guide the next steps but rarely provide the complete picture. That’s why doctors typically use an ultrasound alongside other diagnostic methods like blood tests and physical exams.

The effectiveness of transvaginal ultrasounds (where the ultrasound probe is inserted into the vagina) varies significantly across different studies and clinical settings. Detection rates depend on multiple factors, including cancer stage, equipment quality, technician experience, and patient characteristics. Ultrasounds tend to be more effective at detecting advanced ovarian cancers than early-stage disease, which is, unfortunately, when treatment would be most effective.

And here’s something important: there’s currently no recommended regular ovarian cancer screening test for women at average risk. Multiple extensive studies have shown that routine ultrasound screening hasn’t reduced ovarian cancer deaths in the general population.

What Does Ovarian Cancer Look Like on Ultrasound?

Spotting potential cancer on an ultrasound requires trained eyes. Radiologists and gynecologists look for several concerning features that might suggest malignancy:

• Size and shape: Cancerous masses are often large with irregular borders.
• Internal structure: Malignant tumors frequently show both solid and cystic (fluid-filled) areas.
• Papillary projections: These are finger-like growths that extend inward or outward from the cyst wall.
• Septations: These internal divisions or walls within a mass may appear thick or irregular.
• Blood flow patterns: Cancerous growths typically show increased and abnormal blood flow when examined with Doppler ultrasound. Doppler ultrasound is a specialized technique that detects blood flow patterns during your scan, adding color to the images where blood is moving. Cancerous masses typically develop their own network of irregular blood vessels to fuel their growth, which appears as increased and chaotic blood flow on Doppler. This blood flow information gives doctors another important clue when evaluating whether a mass might be malignant, though it’s still not definitive on its own.
• Ascites: The presence of fluid in the abdomen can be a warning sign (read more about ascites and ovarian cancer).
• Multiple masses: Having tumors in both ovaries raises suspicion.

A simple, fluid-filled cyst with thin, regular walls and no internal structures typically suggests a benign condition. However, a complex mass with solid components, irregular borders, and increased blood flow might warrant further investigation.

But here’s the frustrating reality: some cancerous masses can appear deceptively simple, while some completely benign conditions can look alarmingly complex. This uncertainty is precisely why additional testing is usually needed.

Pelvic Ultrasound Scan

A pelvic ultrasound is the external approach to viewing your reproductive organs. For this procedure:

• You’ll lie on your back on an exam table
• The sonographer will apply clear gel to your lower abdomen
• They’ll move a handheld device (transducer) over your skin
• Sound waves create images of your pelvic organs on a screen

For best results, you might be asked to arrive with a full bladder. This helps push the uterus and ovaries into a position where they’re easier to visualize. The full bladder also provides a “window” through which sound waves can travel more effectively.

The entire process typically takes 15 to 30 minutes and causes minimal discomfort beyond the pressure of the transducer against your abdomen and the inconvenience of a full bladder.

While this external approach is less invasive, it has limitations. The distance between the transducer and the ovaries means image quality may not be optimal. That’s why doctors often recommend combining it with a transvaginal approach.

Transvaginal Ultrasound Scan

The transvaginal ultrasound (TVS) takes imaging to the next level by placing the ultrasound probe closer to the structures being examined. Here’s what to expect:

• You’ll empty your bladder first (yes, opposite of the pelvic ultrasound!)
• You’ll lie on your back with knees bent and legs apart
• The technician covers a slender probe with a protective sheath and lubricating gel
• The probe is gently inserted into the vagina, similar to a tampon
• The probe is moved slightly to capture images from different angles

This approach provides much clearer, more detailed images of the ovaries, fallopian tubes, and uterus because the probe gets much closer to these structures. The improved visualization makes TVS particularly valuable for detecting small abnormalities that might be missed on an external scan.

The entire process usually takes about 15 minutes, and you can return to normal activities immediately afterward.

Can Ovarian Cancer Be Missed On An Ultrasound?

Yes, absolutely. This is a crucial point that needs emphasis.

Ovarian cancer can definitely be missed on ultrasound scans, even when performed by skilled technicians using high-quality equipment. There are several reasons for this:

• Early-stage cancers may be too small to detect or may not have developed characteristic features.
• Some ovarian cancers grow rapidly between screenings.
• The ovaries can be difficult to visualize completely, especially in women with obesity or extensive scar tissue.
• Certain types of ovarian cancer don’t form distinct masses.
• Interpretation is subjective and depends on the skill and experience of the radiologist.
• Normal anatomical variations can sometimes hide abnormalities.

Studies indicate that transvaginal ultrasounds miss approximately 25% of ovarian cancers. Notably, some fast-growing, aggressive forms may develop and spread between regular screening intervals, even with frequent monitoring.

This limitation is precisely why researchers continue searching for better methods for the early detection of ovarian cancer, and why paying attention to persistent symptoms is so important, regardless of normal ultrasound results.

What If My Ultrasound Scan Results Are Normal?

Getting normal results might feel reassuring, but it doesn’t necessarily mean you’re in the clear if you’re experiencing concerning symptoms. Here’s what you should know:

If your symptoms persist despite normal ultrasound results, don’t hesitate to return to your doctor. Many women diagnosed with ovarian cancer report having initially normal scans. Remember: trust your body and advocate for yourself.

Your doctor might recommend:

• Follow-up monitoring with repeat ultrasounds at regular intervals
• Additional testing like CA-125 blood tests or other imaging studies
• Referral to a specialist for further evaluation
• Investigation of other potential causes for your symptoms

Remember that many conditions besides ovarian cancer can cause similar symptoms:

• Irritable bowel syndrome
• Endometriosis
• Fibroids
• Pelvic inflammatory disease
• Urinary tract infections
• Gastrointestinal disorders
• Menopause-related changes

But if your symptoms continue or worsen — especially if you experience persistent bloating, feeling full quickly, pelvic/abdominal pain, or urinary frequency/urgency — don’t accept “normal results” as the final answer. These symptoms, particularly when they’re new and persist for more than two weeks, warrant continued investigation.

Women often know when something feels “off” with their bodies. Trust that instinct and continue seeking answers until you find satisfactory explanations for your symptoms.

Understanding Ultrasound Limitations

To fully grasp how ultrasound fits into ovarian cancer detection, you need to understand its fundamental limitations:

• It’s not a screening tool for the general population. Major medical organizations don’t recommend routine ultrasound screening for women at average risk because studies show it doesn’t reduce mortality and leads to unnecessary surgeries.
• It can’t distinguish between benign and malignant masses with certainty. While certain features raise suspicion, only a biopsy can confirm malignancy.
• Image quality varies. Factors like obesity, bowel gas, previous surgeries, and equipment quality all affect image clarity.
• Interpretation is subjective. Different radiologists might reach different conclusions about the same images.
• It’s a snapshot in time. Cancer can develop or progress after a normal scan.

These limitations don’t mean an ultrasound isn’t valuable; it absolutely is! But understanding these constraints helps set appropriate expectations and emphasizes why multiple approaches to diagnosis are often necessary.

When Should You Get an Ovarian Cancer Ultrasound?

Unlike mammograms for breast cancer, there’s no recommended routine ultrasound screening for ovarian cancer in women without symptoms or high-risk factors. But certain situations call for this imaging:

You should consider an ultrasound if:

• You experience persistent symptoms like bloating, pelvic pain, feeling full quickly, or frequent urination
• You have a family history of ovarian, breast, or colorectal cancer
• You carry BRCA1/BRCA2 or Lynch syndrome gene mutations
• You’ve had breast, uterine, or colorectal cancer previously
• Your doctor detects an abnormality during a pelvic exam
• You have elevated CA-125 levels in blood testing

The bottom line? An ultrasound is most valuable as a diagnostic tool when investigating symptoms or abnormal findings, not as a routine screening measure for 

Advocating for Yourself

Because ovarian cancer can be difficult to detect and diagnose, being your own advocate is essential. Here are some practical steps:

• Track your symptoms: Keep a diary noting when symptoms occur, their severity, and any patterns.
• Be specific with your doctor: Don’t minimize your symptoms or assume they’re normal. Describe them precisely.
• Know your family history: Gather detailed information about cancer in your family, including types and ages at diagnosis.
• Ask questions about test results, next steps, and alternatives.
• Seek a second opinion if you’re not satisfied with the answers you receive, especially if symptoms persist despite normal test results.
• Consider genetic counseling and testing if you have significant family history of ovarian, breast, or related cancers.
• Trust your instincts: If something feels wrong, continue seeking answers.

Remember that you know your body best. While doctors have medical expertise, you’re the expert on your own experience. A good healthcare provider will take your concerns seriously and work collaboratively with you.

The Future of Ovarian Cancer Detection

Current detection methods for ovarian cancer remain imperfect, but promising research continues. Future approaches might include:

• Advanced ultrasound technologies with improved resolution and artificial intelligence interpretation
• Blood-based biomarker panels that measure multiple proteins beyond just CA-125
• Genetic and epigenetic tests that identify DNA changes associated with early cancer
• Combination strategies that integrate multiple testing modalities

Researchers are particularly focused on developing tests that can detect ovarian cancer at Stage I, when survival rates exceed 90%, compared to later stages when survival drops dramatically.

Until better screening methods emerge, awareness of symptoms and prompt investigation remain our best defense. The most promising path forward likely involves combining multiple approaches rather than relying on any single test.

Final Thoughts: Knowledge Is Power

Understanding both the capabilities and limitations of ovarian cancer ultrasound empowers you to make informed healthcare decisions. While this imaging technique isn’t perfect, it remains a valuable tool when used appropriately.

By staying informed and proactive about your health, you give yourself the best possible chance for early detection and successful treatment if ovarian cancer does develop. Knowledge truly is power when it comes to this challenging disease.