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  • How is ovarian cancer diagnosed?

    Contents

    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 here. 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.

    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.

    Investigations

    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.

    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. 

    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 treatmentCA125 blood tests are sometimes included in follow-up tests.

    Imaging

    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, hand-held 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.

    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 (fast) for several hours 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.

    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.

    This website page was last reviewed and updated October 2018.

    Information reviewed by: 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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