Diagnosing ovarian cancer


There is currently no effective screening test for ovarian cancer. If your doctor suspects you have ovarian cancer, you may have some of the tests and scans described in this section. These tests can show if there are any abnormalities that need to be followed up with a biopsy.

The only 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 surgery, which means that the cancer is diagnosed and treated at the same time.

Pelvic examination

The doctor will check for any masses or lumps by feeling your abdomen. To check your uterus and ovaries, they will place two fingers inside your vagina while pressing on your abdomen with their other hand. You may also have a vaginal examination using a speculum, an instrument that separates the walls of the vagina.

An internal examination is not painful but may be uncomfortable. The doctor may also perform a digital rectal examination, placing a gloved finger into the anus to feel the tissue behind the uterus where cancer cells may grow.

The Cervical Screening Test (which has replaced the Pap test) does not diagnose ovarian cancer. It looks for human papillomavirus (HPV), which causes most cases of cervical cancer but not ovarian cancer.

CA125 blood test

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 women with ovarian cancer. However, 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 for screening for ovarian cancer in women who do not have any symptoms. It can be used:

At diagnosis

A CA125 test is more accurate in diagnosing ovarian cancer in women who have been through menopause (postmenopausal) than those who haven't (premenopausal). Women with early-stage ovarian cancer often have normal CA125 levels. This is why doctors will often combine CA125 tests with an ultrasound (see below).

During treatment

If you are found to have ovarian cancer that produces CA125, the blood test may be used to check how well the treatment is working. Falling CA125 levels may mean it's working, and rising CA125 may mean the treatment is not working effectively, but the CA125 level is only one item used by the treating team to assess a woman's response to treatment.

After treatment

CA125 blood tests are sometimes included in follow-up tests.

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.

Pelvic ultrasound

A pelvic ultrasound uses echoes from soundwaves to create a picture of your uterus and ovaries on a computer. A technician called a sonographer performs the scan. It can be done in two ways:

Abdominal ultrasound

You will lie on an examination table while the sonographer moves a small handheld device called a transducer over your abdominal area.

Transvaginal ultrasound

The sonographer will insert a small transducer wand into your vagina. It will be covered with a disposable plastic sheath and gel to make it easier to insert. Some women find this procedure uncomfortable, but it should not be painful. Talk to your doctor and the sonographer if you feel distressed or concerned. You can ask for a female sonographer if that makes you feel more comfortable.

The transvaginal ultrasound is often the preferred type of ultrasound, as it provides a clearer picture of the ovaries and uterus.

"I went in to have minor surgery. Afterwards the doctor said, `I'm sorry, but it looks like ovarian cancer.' It certainly changed my life." – Louisa

CT scan

A CT (computerised tomography) scan uses x-ray beams to take pictures of the inside of the body. It is used to look for signs that the cancer has spread, but a CT scan may not be able to detect all ovarian tumours. CT scans are usually done at a hospital or radiology clinic.

You will be asked not to eat or drink for several hours (fast) before the scan. A liquid dye, sometimes called the contrast, may be injected into one of your veins to help make the pictures clearer. The contrast makes your organs appear white on the scan, so anything unusual can be seen more clearly.

The dye may make you feel hot all over and leave a bitter taste in your mouth. You may also feel the need to pass urine. These side effects usually ease quickly, but tell the person carrying out the scan if they don't go away.

The CT scanner is a large, doughnut-shaped machine. You will lie on a table that moves in and out of the scanner. The scan takes 10–20 minutes, but it may take extra time to prepare and then wait for the scan. While a CT scan can be noisy, it is painless. Most women can go home as soon as the CT scan is over.

The dye used in a CT scan usually contains iodine. If you have had an allergic reaction to iodine or dyes during a previous scan, tell the medical team beforehand. You should also let them know if you're diabetic, have kidney disease or are pregnant.

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 help with planning before surgery, and to check on how the treatment is working. Medicare only covers the cost of PET scans for ovarian cancer that has returned, so they are not often used for the initial diagnosis.

Before the scan, you will be injected with a small amount of radioactive glucose solution. This makes cancer cells show up brighter on the scan because they take up more of the glucose solution than normal cells do. You will be asked to sit quietly for 30–90 minutes while the glucose solution moves around your body, then you will be scanned for high levels of radioactive glucose.

Any radiation will leave your body within a few hours. Let your doctor know beforehand if you are diabetic, pregnant, think you might be pregnant, or are breastfeeding.

Colonoscopy

Some women have a bowel examination (colonoscopy) to make sure that their symptoms are not caused by a bowel problem. The doctor will insert a thin, flexible tube with a small camera and a light (colonoscope) through the anus into the bowel.

Before the test, you will have to change your diet and take prescribed laxatives to clean out your bowel completely (bowel preparation). The process varies for different people and between hospitals. Your doctor will give you specific instructions and talk to you about what to expect. On the day, you will probably be given an anaesthetic so you don't feel any discomfort.

A colonoscopy usually takes about 20–30 minutes. You will need to have someone take you home afterwards, as you may feel drowsy or weak.

Staging and grading ovarian cancer

The tests described above 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.

In most instances, your doctor will not have enough information to work out the stage of the ovarian cancer until after surgery.

The staging system most commonly used for ovarian cancer is the International Federation of Gynecology and Obstetrics (FIGO) system. It divides ovarian cancer into four stages. Each stage is further divided into sub-stages, such as A, B, C, which indicate increasing amounts of tumour.

Stages I–II mean that it is early ovarian cancer. Stages III–IV mean the cancer is advanced. About 7 out of 10 women with ovarian cancer are diagnosed at stages III or IV.

Stages of ovarian cancer (FIGO system)

  • Stage I: Cancer is in one or both ovaries only.
  • Stage II: Cancer is in one or both ovaries and has spread to other organs in the pelvis (uterus, fallopian tubes, bladder or bowel).
  • Stage III: Cancer is in one or both ovaries and has spread beyond the pelvis to the lining of the abdomen (peritoneum) or to nearby lymph nodes.
  • Stage IV: The cancer has spread further to distant organs such as the lung or liver.

Grades of ovarian cancer

Grading describes how the cancer cells look compared to normal cells. It helps work out how aggressive the cancer cells may be. Treatment has a greater chance of success if the grade is lower.

  • Grade 1: The cancer cells look similar to normal cells and are probably growing relatively slowly.
  • Grade 2: The cancer cells appear slightly abnormal and might grow more rapidly.
  • Grade 3: The cancer cells look very different from normal cells and may grow quickly.

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 the disease in an individual person.

Epithelial cancer

The stage and grade of the cancer will influence the outcome. If epithelial ovarian cancer is diagnosed and treated before the cancer has spread outside the ovary (stage I), it has a good prognosis. Many women with more advanced cancer may respond well to treatment, but the cancer often comes back (recurs) and further treatment is needed.

Germ cell and stromal cell tumours

These can usually be treated successfully.

Borderline tumour

This usually has a good prognosis.

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.

Your doctor will consider many factors in assessing your prognosis. These include: test results; the type of ovarian cancer you have; the grade; genetic factors; your response to treatment; and other factors such as your age, fitness and overall health.

Emma's story

"Although I had a long history of gynaecological problems, my diagnosis of ovarian cancer at age 36 was a complete surprise.

"During an emergency operation to fix a twisted ovary, the doctors took a biopsy from an ovarian cyst. Five days later I got a call to say I had ovarian cancer.

"I had surgery to remove my remaining ovary, along with the uterus and some lymph nodes. Luckily the cancer was found early and it hadn't spread outside the ovary.

"As they found a clustering of cells in my abdomen during the surgery, the medical oncologist recommended I have a course of chemotherapy to help prevent the cancer coming back.

"Even though I was young and fit, I found the chemotherapy very difficult. I had treatment weekly for 16 weeks and had a lot of side effects, including fatigue, nausea, diarrhoea and constipation, numbness in the hands and feet, and hair loss. I also had an adverse reaction to the first drug, which meant I had to take medicines before each infusion to try to prevent this.

"Although some people bounce right back, once treatment was over I questioned my values and reasons for being here. Attending support groups and seeing an oncology psychologist really helped me come to grips with the experience of having had ovarian cancer, and my emotions are now in a much better place.

"My body also needed time to recover after treatment. Although I'm still dealing with lymphoedema and fatigue, I'm happy to be getting back to work and my usual activities.

"I now realise how important it is to build a relationship with my health care professionals and to actively look after my health."

Tell your cancer story.

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, advise you about treatment options and perform any recommended surgery. 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).

MDT Health professional
gynaecological oncologist* diagnoses and performs surgery for cancers of the female reproductive system, e.g. ovarian, cervical, uterine, vulvar and vaginal cancers
gynaecological pathologist* examines tissue removed from the abdomen or ovaries under a microscope
medical oncologist* treats cancer with drug therapies including chemotherapy and targeted therapy
radiation oncologist* treats cancer by prescribing and coordinating a course of radiation therapy
radiation therapist plans and delivers radiation therapy
radiologist* reads and interprets diagnostic scans (e.g. x-rays, CT and PET scans)
nurse administers drugs and provides care, information and support throughout treatment
cancer nurse/cancer care coordinator coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment
dietitian recommends an eating plan to follow while you are in treatment and recovery
physiotherapist, occupational therapist assist with physical and practical problems, including restoring mobility after treatment, and recommending aids and equipment
social worker links you to support services and helps you with emotional, practical or financial issues
palliative care specialists* and nurses work closely with the GP and oncologist to help control symptoms and maintain quality of life
familial cancer specialist*, genetic counsellor provide advice about genetic conditions; perform and interpret genetic test results for you and your family

*Specialist doctor

Key points

  • Most ovarian cancers are present for some time before they are diagnosed.
  • A CT scan looks for signs that the cancer has spread. It may not detect all tumours.
  • You will have many tests to check your health, but the only way to definitively diagnose ovarian cancer is by taking a tissue sample (biopsy) during surgery.
  • The doctor will feel your abdomen and do internal vaginal and rectal examinations to check for masses or lumps.
  • Blood tests may be done to look for tumour marker proteins made by cancer cells. The most common tumour marker for ovarian cancer is CA125.
  • An ultrasound scan uses soundwaves to create a picture of the ovaries. The sonographer may pass a small device called a transducer over the abdomen or insert it into the vagina.
  • Results of the diagnostic tests and biopsy help the doctors determine whether and how far the cancer has spread. This is called staging. The grade describes how similar the cancer cells are to normal cells.
  • Prognosis means the expected outcome of a disease. Women with early-stage cancer have the best prognosis.
  • You will be treated by a gynaecological oncologist and other health professionals, who will work together in a multidisciplinary team (MDT).
  • Genetic testing is available on Medicare for many women who are diagnosed with ovarian cancer. It can be organised by your cancer specialists.

Expert content reviewers:

A/Prof Alison Brand, Director, Gynaecological Oncology, Westmead Hospital, and Chair, Australia New Zealand Gynaecological Oncology Group, NSW; Dr Scott Carruthers, Director, Radiation Oncology, Lyell McEwin Hospital, and Deputy Director, Radiation Oncology, Royal Adelaide Hospital, SA; Elizabeth Cooch, Cancer Support Nurse, Ovarian Cancer Australia; Dr Serene Foo, Medical Oncologist, Austin Hospital, Epworth Eastern Hospital, and Mercy Hospital for Women, VIC; Keely Gordon-King, Psychologist, Cancer Council Queensland; Carol Lynch, Consumer; A/Prof Gillian Mitchell, Honorary Medical Oncologist, Familial Cancer Centre, Peter MacCallum Cancer Centre, and The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC; Claire Quenby, Social Worker, King Edward Memorial Hospital for Women, WA; Jan Priaulx, 13 11 20 Consultant, Cancer Council NSW; Hayley Russell, Support Coordinator, Ovarian Cancer Australia.

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