Being diagnosed with cancer of the ovary, fallopian tube or peritoneum

If you have symptoms you usually start by seeing your GP. They will examine you and may arrange some tests. If your GP is worried about cancer they will arrange for you to see a specialist doctor within 2 weeks. This is usually a gynaecologist (a doctor who treats female reproductive system problems).

At the hospital the specialist will examine you again and may arrange more tests.

Tests include:

  • internal examination to feel inside the vagina for lumps or swellings
  • blood test to check CA125 protein levels which may be higher if you have cancer
  • Ultrasound scans to build up a picture of the organs inside the abdomen (tummy area) and pelvis
  • Collecting samples of abnormal cells to examine under the microscope
  • CT scan to build up a 3D picture of the inside of the body
  • blood test to look for genetic changes linked to cancer.

Waiting for test results can be a difficult time. You may find it helpful to talk to someone such as your partner, family, friend or specialist nurse.

How cancer of the ovary, fallopian tube or peritoneum is diagnosed

You usually start by seeing your GP. Your GP will ask about your symptoms and do an internal (vaginal) examination to check for any lumps or swellings.

They will also arrange for you to have:

  • a blood test called a CA125 test
  • an ultrasound scan to look at your ovaries.

There is more information about having an internal examination and tests below.

If your GP is worried about cancer, they will arrange for you to see a specialist doctor within two weeks. This specialist is usually a gynaecologist (a doctor who treats female reproductive system problems).

Some people are admitted directly to hospital if they have a symptom that is making them very unwell.

When I was diagnosed, I was able to say “I have ovarian cancer”. Because I was able to talk about it, I didn’t feel shame or embarrassment.

Clara


At the hospital

The specialist doctor will ask you about your general health, any previous health problems, and whether you have any history of cancer in your family. They will do an internal (vaginal) examination again. If you have not already had a CA125 blood test and ultrasound, they will usually arrange for you to have these tests.

The doctor may use the results of these tests to check your Risk of Malignancy Index (RMI) score. This is a system that checks how likely it is that your symptoms are caused by cancer. It takes into account:

  • whether you have gone through the menopause
  • the level of CA125 in your blood
  • the results of your ultrasound.

They may also organise further tests, such as a CT scan (see below). These tests help your team diagnose the cancer and plan your treatment.

You may also meet a nurse specialist. They can give you advice and support. Your doctor or nurse will explain any tests you need. If you have questions or need more information, just ask.


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. It should not be painful, but may be uncomfortable.

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.

Internal examination
Internal examination

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They may put an instrument called a speculum into your vagina. They use this to hold the vagina walls apart, so they can check that your cervix looks normal.

Checking the cervix
Checking the cervix

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If you have questions or worries about having an internal examination, tell the nurse or doctor. They can answer any questions you have and explain ways they can make it easier for you.


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 will explain more about it and help you lie down comfortably on your back.

You may have a:

  • Pelvic ultrasound – You will be asked to drink plenty before this test so that your bladder is full. They spread a gel on to your abdomen and gently press a small hand-held device against your skin. This produces the sound waves.
  • Vaginal ultrasound – They gently put a small ultrasound probe into your vagina. The probe is about the size of a tampon and produces the sound waves. Although this scan sounds uncomfortable, some people find it easier than a pelvic ultrasound, as you do not need a full bladder.


Removing fluid from the abdomen

Sometimes swelling or bloating in the tummy is caused by a build-up of fluid. This is called ascites. It can be caused by 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 collect some fluid in 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 (called ascitic drainage). We have more information about ascitic drainage.


CT (computerised tomography) scan

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 to 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.

CT scan
CT scan

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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 is important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

You will probably be able to go home as soon as the scan is over.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


Biopsy

This is when the doctor removes a small sample (biopsy) from the lump or abnormal area. The sample is then sent to the laboratory and looked at under a microscope. This test checks that the abnormal area is cancer. It also finds out more about the type and grade of the cancer.

If your first treatment is likely to be surgery to remove a tumour, biopsies are often taken during your operation. Sometimes a biopsy is needed before any treatment starts, to check that your symptoms are definitely caused by cancer and not by another condition. For example, you may have this test if your doctor thinks you need chemotherapy as your first treatment.

If you need a biopsy before treatment, this will usually be an image guided biopsy. Less often, some people have surgery to look inside the abdomen and collect samples.


Image guided biopsy

Your doctor numbs your skin using a local anaesthetic injection. You may also have a sedative to help you relax. The doctor passes a needle through the skin, using a CT or ultrasound scan to guide them to the right place. They collect a small sample from the abnormal area with the needle.

You will usually stay in hospital for a few hours after this test, and sometimes overnight.


Surgery to take biopsies

This is usually done with an operation called a laparoscopy (or keyhole surgery). You have a general anaesthetic. You can usually go home later the same day or the next day.

The surgeon makes three or four small cuts in the lower abdomen. The cuts are about 1cm long. The surgeon pumps some gas into the abdomen to lift up the tummy wall, so the organs can be seen clearly. The surgeon then puts a thin tube with a tiny camera on the end into the abdomen. This is called a laparoscope. They examine the area carefully and take biopsies.

You may have discomfort in your neck or shoulder after the operation. This will go away after a day or two. Walking about may help. Some people have cramps or painful wind in the tummy. Taking sips of peppermint water and moving around can help.

Sometimes an operation called a laparotomy is done instead. The surgeon uses one larger cut to open the abdomen and look inside. If cancer is found, they 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 having surgery and what to expect.


Genetic testing

Your doctor may talk with you about having a blood test to look for genetic changes that are linked to cancer. This is only done if you have certain types of cancer, such as high-grade serous or endometrioid cancer.

Knowing about any genetic changes helps your doctor plan your treatment.

We have more information about cancer and genetic changes.


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 can also provide support. You can also talk things over with one of our cancer support specialists on 0808 808 00 00.

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