Being diagnosed with ovarian cancer

If your doctor thinks you may have ovarian cancer, they will refer you to a gynaecologist for more tests. A gynaecologist is a specialist in women’s health. The referral should happen within two weeks.

You will see a gynaecologist in hospital. They will ask you about your general health, any previous health problems, and whether you have a history of cancer in your family. They will arrange for you to have a blood test and an ultrasound scan. An ultrasound uses sound waves to build up a picture of internal organs. You may need further tests, and an operation to help doctors look more closely at the ovaries and area around them. Your doctor will explain what this might involve.

Waiting for test results can be a very worrying time. You may find it helpful to talk through your feelings with your doctor or a close friend.

How ovarian cancer is diagnosed

Most women are diagnosed after going to see their GP when they notice symptoms. Your GP will ask about your symptoms and carry out an internal (vaginal) examination to check for any lumps or swellings.

They will arrange for you to have a blood test called a CA125 test and an ultrasound scan to look at your ovaries.

If your GP suspects ovarian cancer, they will refer you to a gynaecologist (a specialist in women’s health), or a gynaecology cancer team, within two weeks. Sometimes women are admitted directly to hospital if they have a symptom that is making them very unwell.


At the hospital

At the hospital, the gynaecologist will ask you about your general health, any previous health problems, and whether you have any history of cancer in your family. If you have 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. You may be introduced to a clinical nurse specialist before or after you have your tests. They will give you information and support during and after treatment.

Your specialist doctor will explain the tests you need to have to diagnose ovarian cancer. Some tests may also be used to find the stage of the cancer.


Internal (vaginal) examination

Your doctor will do an internal examination to check for any lumps or swelling in the ovaries or womb. It takes about five minutes and shouldn’t be painful but may be uncomfortable. You can ask for a female doctor to examine you if you prefer.

You lie on a couch, with your feet drawn up and knees apart. The doctor places one or two gloved fingers into your vagina and gently presses on your lower tummy with their other hand. They may put a speculum (which holds the vaginal walls apart) into the vagina to check that your cervix looks normal.


CA125 blood test

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 can also be raised by non-cancerous conditions and by other types of cancer.

In early ovarian cancer, CA125 levels may be normal.


Ultrasound scan

An ultrasound scan uses sound waves to build up a picture of the organs inside the abdomen (tummy area) and the pelvis. A computer converts the sound waves into pictures that you can see on a screen.

You have the scan in the hospital scanning department. The person doing the scan (ultrasonographer) will explain more about it and help you lie down comfortably on your back.

There are two types that can be used:

  • Pelvic ultrasound – You’ll be asked to drink plenty of fluids before this test so that your bladder is full. They spread a gel on to your abdomen and gently go over the area with a small hand held device, which produces the sound waves.
  • Vaginal ultrasound – They gently insert the tip of an ultrasound probe (tampon size) into your vagina. The probe produces sound waves. Although this scan may sound like it will be uncomfortable, you may find it easier than a pelvic ultrasound, as you don’t need a full bladder.


Risk of malignancy index (RMI)

Your gynaecologist may use a scoring system called the RMI to assess whether a lump or swelling on the ovary is likely to be a cancer.

It takes into account:

  • whether a woman has gone through the menopause
  • the level of CA125 in the blood
  • the results of an ultrasound.


Removing fluid from the abdomen

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 this fluid to check for cancer cells.

The doctor injects some local anaesthetic into the skin on your tummy (abdomen) to make it numb. They gently pass a small needle through the skin and withdraw a sample 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, it can be uncomfortable so your doctor may remove it. You can have this done in the outpatient clinic or ward.

The doctor puts a fine tube called a cannula through the skin. The tube attaches to a drainage bag that collects the fluid as it drains from your tummy.

We have more information about ascites.


CT scan

A CT (computerised tomography) scan uses x-rays to build a three-dimensional picture of the inside of the body. You may be given either a drink or injection of dye. This is to make certain areas of the body show up more clearly. This scan takes around 30 minutes and is painless. We have more detailed information about having a CT scan.


Image-guided biopsy

This test removes a sample of the tumour (biopsy) so that it can be tested to confirm the diagnosis of ovarian cancer. Your doctor may recommend this if other test results strongly suggest you have ovarian cancer and they think you should have chemotherapy before surgery.

Your doctor numbs the skin over the ovary using a local anaesthetic injection. You may also be given a sedative to help you relax.

The doctor passes a needle through the skin into the tumour using a CT or ultrasound scan to guide them to the right place. They remove a small sample of tissue (a biopsy) from the tumour. This is then sent to the laboratory for checking.

You need to stay in hospital for a couple of hours after a biopsy, and possibly overnight because of the risk of bleeding afterwards.


Using surgery to diagnose

Often the only way to be certain whether a lump on the ovary is cancer is to do an operation to look at the ovaries and the surrounding area. This is usually done with an operation called a laparoscopy (or keyhole surgery). Sometimes an operation called a laparotomy using one larger cut to open the abdomen and look inside is done instead.

Doctors can take samples of tissue during surgery to check for ovarian cancer cells.

Laparoscopy

This operation allows the doctor to look at the ovaries the surrounding area and other organs and take small samples of tissue (biopsies). 

It’s done under a general anaesthetic. You can usually go home the same day, but some women may have to stay in hospital overnight.

The surgeon makes 3–4 small cuts (1cm long) in the skin and muscle of the lower abdomen. They pump some carbon dioxide gas into the abdomen to lift up the tummy wall, so 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. They examine the area and take biopsies that are checked for cancer cells.

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 afterwards but this will go away after a day or two. Walking about can help relieve it. Some women have uncomfortable wind in the tummy after surgery. Taking sips of peppermint water and moving around can help.

Laparotomy

If a laparoscopy isn’t suitable for you, your surgeon may carry out a laparotomy.

You have this under a general anaesthetic. The surgeon makes a vertical (‘up and down’) cut from your bikini line to your belly button or just above it. They examine your ovaries and the organs nearby and take small samples of tissue (biopsies).

Sometimes if cancer is found, the surgeon may then operate to remove the cancer. This is only done if you and your doctor have discussed it and you have agreed (consented) to it before the operation.

We have more information about surgery for ovarian cancer and about recovering after an operation.


Waiting for test results

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 your partner, family or a close friend. Your specialist nurse or one of the organisations listed on our database, can also provide support. You can also talk things over with one of our cancer support specialists on 0808 808 00 00.