If your doctor suspects you have ovarian cancer, they will usually start with a pelvic examination. To confirm the diagnosis, tissue from the tumour needs to be checked under a microscope. This tissue can be obtained with a biopsy (piece of tissue or fluid sample from the abdomen) or at the time of surgery.
Sometimes ovarian cancer is diagnosed before it causes symptoms. This is usually when abnormalities are found during tests or procedures for another health condition.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for ovarian cancer can help you make sense of what should happen. It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
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In a pelvic examination, the doctor will press gently on different parts of the outside of your abdomen (belly) to feel for any masses or lumps.
To check your uterus and ovaries, the doctor will place two gloved fingers into your vagina while pressing on your abdomen with their other hand. You may also have a vaginal examination using an instrument that gently separates the walls of the vagina.
A pelvic examination is not painful but it may be uncomfortable. There might be another health professional in the room or, if there isn’t, you can ask for a staff member or a family member or friend to be present during the examination if you prefer.
The doctor may also perform a digital rectal examination, placing a gloved finger into the anus and rectum. This lets the doctor feel the tissue behind the uterus where cancer cells may grow.
You may have blood tests to check for proteins produced by cancer cells. These proteins are called tumour markers. The most common tumour marker for ovarian cancer is CA125.
The level of CA125 may be higher in some cases of ovarian cancer. It can also rise for reasons other than cancer, including ovulation, menstruation, irritable bowel syndrome, liver or kidney disease, endometriosis or fibroids.
The CA125 blood test is not used to screen for ovarian cancer if you do not have any symptoms. It can be used at diagnosis, during and after treatment.
Your doctor may recommend a number of imaging scans to look for any pelvic mass, but they don’t confirm if any mass found is cancer. Imaging scans can also work out how far the cancer has spread.
Types of imaging scans
Pelvic ultrasound – uses soundwaves to create a picture of your uterus and ovaries. The soundwaves echo when they meet something dense, like an organ or tumour, then a computer creates a picture from these echoes. A pelvic ultrasound can be done in two ways – abdominal (a small handheld device is moved over your abdomen) or transvaginal (small transducer wand is inserted into your vagina). The transvaginal ultrasound is often the preferred type of ultrasound, as it provides a clearer picture of both the ovaries and uterus.
CT scan – uses x-rays to create a detailed picture of the inside of the body. A CT scan is used to check your abdomen, chest and pelvic area, look for signs that the cancer has spread outside the ovaries and guide the needle when doing a biopsy.
PET–CT scan – a specialised imaging test that provides more information about the activity of the cancer than a CT scan on its own, which mainly shows the shape and size of the tumours. Only some people need a PET–CT scan. Medicare covers the cost of PET scans only for ovarian cancer that has returned, so they are not often used to look for ovarian cancer.
MRI scan – uses a powerful magnet and radio waves to build-up detailed pictures of the inside of your body. While not often used, an MRI may help if it is difficult to tell from the ultrasound whether an ovarian tumour is likely to be cancerous.
Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast during previous scans. You should also let them know if you have diabetes or kidney disease, or are pregnant or breastfeeding.
Genetic testing after diagnosis
If you are diagnosed with epithelial ovarian cancer, your treatment team or a family cancer centre will discuss with you the option to have a blood test to look for a fault in the BRCA1, BRCA2 or another similar gene.
This genetic test may be available through the public hospital system or with a Medicare rebate. The results will help work out if the ovarian cancer is sensitive to treatments such as targeted therapy.
If a cancer-related gene fault is found, Medicare rebates the cost of testing close adult female and male relatives to check their risk (men can inherit and pass on BRCA faults and may have a higher risk of prostate cancer).
Learn more about genetic testing
Taking a biopsy
The only way to confirm the diagnosis of ovarian cancer is to remove a sample of tissue from the tumour (biopsy). This is sent to a specialist called a pathologist who checks it under a microscope for cancer cells.
In some cases, the diagnosis is confirmed after tissue is removed during surgery. If you cannot have surgery because the cancer has spread or because of some other medical condition, a biopsy may be taken in a different way.
Staging ovarian cancer
Tests help show whether you have ovarian cancer and whether it has spread to other parts of the body. This process is called staging and it helps your health care team recommend the best treatment for you.
The staging system most commonly used for ovarian cancer is the International Federation of Gynecology and Obstetrics (FIGO) system. This system divides ovarian cancer into four stages.
Stages 1–2 mean it is early ovarian cancer. Stages 3–4 mean the cancer is advanced. About 7 out of 10 cases of ovarian cancer are diagnosed at stage 3 or 4.
Grading ovarian cancer
The cancer will also be given a grade, which suggests how quickly the cancer may grow. Different systems are used to grade ovarian cancer, depending on the type.
Epithelial ovarian cancer is simply divided into low grade and high grade and a number is not given. The most common type of ovarian cancer is high-grade serous cancer. All other types of ovarian cancers are graded as 1, 2 and 3 – 1 being low grade and 3 being high grade.
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 anyone to predict the exact course of the disease. To work out your prognosis, your doctor will consider:
- test results
- the type of ovarian cancer, its stage and grade
- genetic factors
- likelihood of response to treatment
- factors such as your age, fitness and overall health.
If epithelial ovarian cancer is diagnosed and treated when the cancer is inside the ovary (stage 1), it has a good prognosis. Many cases of more advanced cancer may respond well to treatment, but the cancer often comes back (recurs) and further treatment is needed.
Stromal cell and germ cell tumours can usually be treated successfully, although there may be a small risk the cancer will come back and need further treatment. Borderline tumour can usually be treated successfully with surgery alone.
Discussing your prognosis can be challenging and stressful. It may help to talk with family and friends, or call our cancer nurses on 13 11 20.
Understanding Ovarian Cancer
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Expert content reviewers:
Dr Nisha Jagasia, Gynaecological Oncologist, Mater Hospital Brisbane, QLD; Sue Hayes, Consumer; Bronwyn Jennings, Gynaecology Oncology Clinical Nurse Consultant, Mater Health, QLD; Dr Andrew Lee, Radiation Oncologist, Canberra Region Cancer Centre and Canberra Hospital, ACT; A/Prof Tarek Meniawy, Medical Oncologist, Sir Charles Gairdner Hospital, WA; Caitriona Nienaber, Cancer Council WA; Jane Power, Consumer; A/Prof Sam Saidi, Senior Staff Specialist, Gynaecological Oncology, Chris O’Brien Lifehouse, NSW.
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The information on this webpage was adapted from Understanding Ovarian Cancer - A guide for people with cancer, their families and friends (2022 edition). This webpage was last updated in April 2022.