Diagnosis of ovarian cancer
Several tests may be needed to diagnose ovarian cancer.
Usually you begin by seeing your GP. They’ll ask about your symptoms and carry out an internal (vaginal) examination to check for any lumps or swellings. Your GP may also arrange for you to have a blood test called a CA125 test. Depending on the results, they may arrange for you to have an ultrasound scan to look at your ovaries.
If your GP suspects you may have ovarian cancer, they’ll refer you to be seen within two weeks by a gynaecologist (a specialist in women’s health), or by a specialist gynaecology cancer team. Sometimes women are admitted directly to hospital if they have a symptom that’s making them very unwell.
At the hospital, the gynaecologist will ask you about your general health, any previous health problems you’ve had, and about your family history of cancer. If you’ve not already had a CA125 blood test and ultrasound, they’ll usually arrange for you to have these tests. They may also organise further tests, such as a CT scan.
Several tests may be needed to diagnose ovarian cancer. Some tests may also be used to find the stage of the cancer. You may have some of the following tests:
Internal (vaginal) examination
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This test may be done to check for any lumps or swelling in the ovaries or womb.
It takes about five minutes.
It involves lying on a couch, with your feet drawn up and knees apart. The doctor places one or two gloved fingers into your vagina, while pressing down on your lower tummy with their other hand.
The doctor may then put a speculum (which holds the vaginal walls apart) into the vagina to check that your cervix looks normal.
An internal examination shouldn’t be painful but may be uncomfortable. You can ask for a female doctor to perform the internal examination if you prefer.
You’ll have a blood test to check for raised levels of a protein called CA125. It’s normal to have some CA125 in the blood, but the level may be higher in women with ovarian cancer. The level of CA125 in the blood can also be raised by non-cancerous conditions and by other types of cancer.
An ultrasound scan uses sound waves to build up a picture of the organs inside the abdomen (tummy area) and the pelvis. It’s done in the hospital scanning department. There are two types of ultrasound that can be used to check the ovaries for abnormalities:
You’ll be asked to drink plenty of fluids before the test so that your bladder is full. This helps to give a clearer picture. Once you’re lying comfortably on your back, a gel is spread on to your abdomen. A small device, which produces sound waves, is then rubbed over the area. The sound waves are converted into a picture by a computer.
A probe with a rounded end is put into your vagina. The probe produces sound waves, which are converted into a picture by a computer. Although this type of ultrasound scan may sound uncomfortable, many women find it more comfortable than having a pelvic ultrasound, as it doesn’t involve having a full bladder.
After the ultrasound is complete, the pictures will be checked for signs that may indicate ovarian cancer.
Risk of malignancy index (RMI)
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Most lumps or swellings (masses) on the ovary aren’t due to cancer, so your gynaecologist may use a scoring system called the RMI to assess whether a mass on the ovary is likely to be a cancer. The RMI takes into account:
whether a woman has gone through the menopause
the level of CA125 (a tumour marker) in the blood
the results of an ultrasound.
Removing fluid from the abdomen
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Sometimes swelling or bloating in the tummy can be due to a build-up of fluid. This is called ascites and it can be caused by ovarian cancer or by other non-cancerous conditions. If you have ascites, your doctor may want to take a sample of fluid to check for cancer cells.
The doctor injects some local anaesthetic into the skin on your abdomen. Once the skin is numb they pass a small needle into the abdomen and draw some of the fluid into a syringe. The fluid is sent to the laboratory to be examined.
If you have a lot of fluid in your abdomen, the doctor may remove it to help you feel comfortable. This can be done in the outpatient clinic or ward. The doctor puts a fine tube called a cannula into the abdomen. They then attach the cannula to a drainage bag, which collects the fluid as it drains from the abdomen.
We have more information available about ascites.
CT (computerised tomography) scan
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A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10–30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You’ll be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you’re allergic to iodine or have asthma, because you could have a more serious reaction to the injection.
You’ll probably be able to go home as soon as the scan is over.
This test may be done if the results of the tests you’ve had strongly suggest that you have ovarian cancer and your treatment plan involves you having chemotherapy before surgery. It’s done so that a sample of the tumour can be tested to confirm that you have ovarian cancer and find out what type it is.
Before the test, the doctor numbs the skin using a local anaesthetic injection. You may also be given a sedative to help you relax. Then, using a CT or ultrasound scanner to guide them to the right place, the doctor passes a needle through the skin and into the tumour. They use the needle to remove a small sample of tissue (a biopsy) from the tumour. This is then sent to the laboratory for checking.
You’ll need to stay in hospital for a couple of hours after a biopsy, and possibly overnight. This is because there’s a risk of bleeding afterwards. If you’ve been given sedation, you’ll need someone to take you home and to stay with you for 24 hours until the effects have completely worn off.
Often the only way to be completely sure whether a lump (mass) on the ovary is cancer is to do an operation to look at the ovaries and the surrounding area. This is usually done using an operation called a laparoscopy (also called minimally invasive surgery or keyhole surgery). But sometimes a laparotomy (an operation using one larger cut to open the abdomen and look inside) is done instead.
This operation allows the doctor to look at the ovaries, the fallopian tubes, the womb and the surrounding area. It’s done under a general anaesthetic. Most women usually go home the same day, but you may have to stay in hospital overnight.
While you’re under the anaesthetic, the doctor makes 3–4 small cuts in the skin and muscle of the lower abdomen. Each cut is approximately 1cm (around half an inch) long. Some carbon dioxide gas is pumped into the abdomen to lift up the tummy wall, so that the organs can be seen clearly. The doctor then puts a thin fibre-optic tube with a tiny camera on the end (called a laparoscope) into the abdomen. This allows them to look at the ovaries and other organs and to take small samples of tissue (biopsies).
You should be able to get up as soon as the effects of the anaesthetic have worn off.
You may have discomfort in your neck and/or shoulder after the laparoscopy. This will go away after a day or two. Walking about can help relieve it. Some women have uncomfortable wind in the abdomen after surgery. Taking sips of peppermint water and moving around can help.
If a laparoscopy isn’t suitable for you, your surgeon may carry out a laparotomy.
This operation is done under a general anaesthetic. The surgeon makes a vertical (‘up and down’) cut from your bikini line to your belly button (umbilicus) or just above it. This lets them examine your ovaries and the organs nearby. They’ll take small samples of tissue (biopsies) from the ovaries and from other tissues. Sometimes if cancer is found, the surgeon may operate to remove the cancer. This would only be done if you’d discussed and agreed (consented) to this before the operation.
We have more information about surgery to remove ovarian cancer and about recovery after a laparotomy.
Waiting for test results
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Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready. You may find it helpful to talk with a partner, family or a close friend. Your specialist nurse can provide support or you can talk things over with one of our cancer support specialists.