Diagnosing ovarian cancer

Tuesday 1 April, 2014

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On this page: Physical examination | Blood tests | Imaging and investigations | Staging ovarian cancer | PrognosisWhich health professionals will I see? | Key points


The tests and scans described in this section can show if there are abnormalities, but they cannot provide a diagnosis. The only definitive way to confirm a diagnosis of ovarian cancer is by taking a tissue sample (biopsy) and looking at the cells under a microscope. This is usually done during an operation, which means that the cancer is diagnosed and treated at the same time.

Sometimes ovarian cancer is found unexpectedly during another operation, such as a hysterectomy (when the uterus is removed). Most ovarian cancers are present for some time before they are diagnosed.

Physical examination

The doctor will check for any masses or lumps by feeling your abdomen and doing an internal vaginal examination. If you are uncomfortable with this, you can ask for a female doctor or have someone else with you for support. If there is a build-up of fluid in the abdomen, your doctor may give you a local anaesthetic and pass a needle through your skin to take a fluid sample. This is called paracentesis. The fluid is checked under a microscope for cancer cells.

The Pap test is not designed to detect ovarian cancer. Its purpose is to look at cells on the cervix. Rarely, a Pap test may show cancer cells that have spread from the ovary to the cervix.

Blood tests

You may have blood tests to check for chemical proteins produced by cancer cells. These are called tumour markers. The most common tumour marker for ovarian cancer is CA-125.

The level of CA-125 may be higher in women with ovarian cancer. However, it can also be raised in women who have non-cancerous conditions, including irritable bowel syndrome, kidney disease, liver disease, endometriosis or fibroids. This is why doctors will not rely on CA-125 levels alone for a diagnosis, and why blood tests are often used in combination with an ultrasound (see below).

Blood tests may also be done during and after treatment to check the effects of the treatment on your body and the cancer.

Imaging and investigations

Your doctor may recommend a number of imaging scans and investigations to determine the extent and stage of the disease. You may also have chest x-rays to check the lungs for cancer or fluid. 

Ultrasound

An ultrasound uses echoes from soundwaves to create a picture on a computer. This test is one of the best ways to view the ovaries. The scan can be done in two ways:

  • Abdominal ultrasound: You will lie on an examination table and a hand-held device called a transducer is passed over your abdominal area. This creates images of your organs on a screen.
  • Transvaginal ultrasound: The doctor will insert the transducer into your vagina. This is often the preferred type of ultrasound, as it provides a clearer picture of your ovaries and uterus.

Some women find the transvaginal ultrasound procedure uncomfortable, but it should not be painful. Talk to your doctor and the person performing the ultrasound (sonographer) if you feel embarrassed or concerned.

PET scan

A PET (positron emission tomography) scan highlights abnormal tissues in the body, and it can be more accurate than a CT scan. The results are often used to determine what combination of treatment is most likely to be successful, to help with planning before surgery, to check on how the treatment is working.

You will be injected with a glucose solution containing a small amount of radioactive material. The solution circulates in your body and is taken up by actively dividing cells, such as cancer cells. You will then have a full body scan.

The scan takes about 2–3 hours. You are usually allowed to bring a music CD to the procedure. The radiation will leave your body within a few hours, but talk to your doctor beforehand if you are concerned about the effects of the radiation, or if you are pregnant, think you might be pregnant, are breastfeeding, or diabetic.

PET scans may not be available at your local hospital. Some people have to travel to a centre where a PET scanner is located. 

CT scan

A CT (computerised tomography) scan uses x-ray beams to take pictures of the inside of your body. It is used to look for signs that the cancer has spread, but the CT scan may not be able to detect all ovarian tumours.

CT scans are usually done at a hospital or a radiology clinic. You will be asked not to eat or drink anything for several hours (fasting) before the scan, except for a liquid dye. The dye makes your organs appear white on the scan, so anything unusual can be seen more clearly. You may also have an injection of dye to help the organs appear clearer.

After the dye has been injected, you may experience a bitter taste in your mouth, you may feel flushed, and you may experience abdominal discomfort. Symptoms should ease quickly but tell the person carrying out the scan if you feel unwell.

You will lie on a table while the scanner, which is large and round like a doughnut, moves around you. It can be noisy. The scan takes 10–20 minutes but it may take extra time to prepare and then wait for the scan.

The dye used for a CT or MRI scan is called a contrast solution and may contain iodine. If you are allergic to iodine, fish or dyes, let the person performing the scan know in advance. You should also let the doctors know if you have a pacemaker, as you may not be able to have an MRI scan due to the effect of the magnet. 

"Calling Cancer Council after diagnosis helped me take in the new information." - Luisa 

MRI scan 

An MRI (magnetic resonance imaging) scan uses magnetism and radio waves to build up cross-section pictures of your body. This scan is not commonly used for women with ovarian cancer.

Before the scan, you may be asked not to eat or drink for a few hours. You may be given an injection of dye to highlight the organs in your body.

You will lie on an examination table inside a large metal tube that is open at both ends. The tube makes some people feel afraid of being confined in a small space (claustrophobic). It can also be noisy. If you are uncomfortable, you may be given medication to help you relax, earplugs to reduce the noise level, or headphones to listen to music. You may also be able to take someone into the room with you for reassurance and company. 

Colonoscopy

Some women have a bowel examination (colonoscopy) to make sure that symptoms are not due to a bowel problem. The doctor will insert a thin, flexible tube with a small camera and a light (endoscope) into your bowel.

You may have to fast (no eating or drinking) and take laxatives to empty your bowels the day before the test. Your doctor will talk to you about what to expect.

Staging ovarian cancer

Results of the diagnostic tests and biopsies help the doctors determine how far the cancer has spread. This is called staging.

Staging the cancer helps your health care team decide what treatment is best for you. Some of the stages are further divided into sub-stages. If you have difficulty understanding the stage of the cancer, ask your doctor to explain the stage in simple terms.

  • Stage 1: Cancer is in one or both ovaries.
  • Stage 2: Cancer is in one or both ovaries and has spread to other organs in the pelvis.
  • Stage 3: Cancer is in one or both ovaries and has spread beyond the pelvis to the lining of the abdomen, the bowel or lymph nodes in the abdomen or pelvis.
  • Stage 4: The cancer has spread further, to the inside of the bladder or rectum, throughout the abdomen or to other body parts.
"I just held her while she cried...that was the day she was told...then it was all about being positive. Getting through. Not letting it beat her." – Ann, daughter of Susan Renouf Extract from the Good Weekend, Force of Life, 16 November 2013

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of your illness.

  • For women with epithelial ovarian cancer, the outcome depends to a large extent on the stage of the disease. Women diagnosed with stage 1 cancer have a good prognosis and the cancer can usually be cured. Many women with more advanced cancer may respond well to treatment, but the cancer often comes back at a later time.
  • Non-epithelial cancers can usually be treated successfully.
  • Borderline tumours usually have a good prognosis regardless of when they are diagnosed. Discussing your prognosis and thinking about the future can be challenging and stressful. It may help to talk with family and friends.

You can also call Cancer Council 13 11 20 if you need more information or emotional support.

Test results, the type of ovarian cancer you have, the rate and depth of tumour growth, how well you respond to treatment, and other factors such as age, fitness and your medical history are all important factors in assessing your prognosis. 

Which health professionals will I see?

 Your GP will probably arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a gynaecological oncologist, who specialises in treating women with ovarian cancer.

The gynaecological oncologist may arrange further tests and advise you about treatment options.

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. This is often referred to as a multidisciplinary team (MDT).

Specialist health professionals
  • gynaecological oncologist: a specialist surgeon who treats women who have cancers of the reproductive system, e.g. ovarian, cervical, vulvar and vaginal cancers
  • medical oncologist: prescribes and coordinates the course of chemotherapy
  • radiation oncologist: prescribes and coordinates the course of radiotherapy
  • radiologist: a specialist trained to read and interpret diagnostic scans (e.g. CT, MRI and PET scans)
  • oncology nurses: help administer drugs, including chemotherapy, and provide care, information and support throughout your treatment
  • cancer nurse coordinator or cancer care coordinator: supports patients and families throughout treatment and liaises with other staff
  • dietitian: recommends an eating plan for you to follow while you are in treatment and recovery
  • physiotherapist and occupational therapist: help you manage any physical or practical issues, including any rehabilitation you may need
  • social worker, counsellor and clinical psychologist: link you to support services and help you with any emotional problems
  • palliative care team: helps you and your family with needs you have, including symptom management

Key points

  • Most ovarian cancer tumours are present for some time before they are diagnosed.
  • The doctor will do many tests to check your health, but the only way to definitively diagnose ovarian cancer is by taking a tissue sample (biopsy) during the operation.
  • The doctor will look at your abdomen and vagina to check for masses, lumps or fluid.
  • Blood tests may be done to look for chemical proteins made by cancer cells, called tumour markers.
  • An ultrasound scan uses soundwaves to create a picture of the ovaries. the doctor may pass a small device over your abdomen or insert it into your vagina.
  • The CT scan uses x-ray beams to take pictures of the inside of your body. It may not detect all tumours.
  • MRI scans use magnetism and radio waves to create pictures of your body. They are less commonly used to diagnose ovarian cancer.
  • Some women have other tests, such as a bowel examination (colonoscopy) or PET scan.
  • Results of the diagnostic tests and biopsy help the doctors work out how far the cancer has spread. This is called staging.
  • Prognosis means the likely outcome of your illness. Women with early stage cancer have the best chance of long-term survival or cure.
  • You will see a team of health professionals, including a gynaecological oncologist and oncology nurses, who will provide care and advice.

Reviewed by: A/Prof Martin K Oehler, Department of Gynaecological Oncology, Royal Adelaide Hospital, SA; Lucinda Hossack, Cancer Genetic Counsellor, Peter MacCallum Cancer Centre, VIC; Dr Kevin Palumbo, Radiation Oncologist, Adelaide Radiotherapy Centre, Flinders Private Hospital, SA; Nicole Wilton, Support Programs Manager, Ovarian Cancer Australia, VIC; Ilka Carapina, Consumer; and Cancer Council Queensland Helpline Operators.

Updated: 01 Apr, 2014