Tests for ovarian cancer
There are a number of tests you might have to find out the cause of your symptoms. If you have ovarian cancer, you usually have further tests to find out how big the cancer is and whether it has spread. This might include all or some of the following:
-
blood tests
-
ultrasound scan
-
taking a sample of tissue called a biopsy
Before any test or examination, your GP or specialist will explain what they are going to do. Ask them if you are not clear about anything.
Tests your GP might do
Most people with symptoms that could be due to cancer start by contacting their GP surgery. Your first appointment may be a telephone appointment. Your GP surgery then might arrange for you to go in and see a doctor or other healthcare professional.
Your GP can do some tests to help them decide whether you need to see a specialist. This usually includes:
- physical examination
- blood tests including the
CA125 
blood test - ultrasound scan
Depending on your symptoms, your GP may also ask you to have other tests. For example, they might arrange for you to have:
- a urine test to check for infection
- a test that looks for blood in a sample of your poo (stool)
Physical examination
Your GP usually does a physical examination. This includes looking at and feeling your:
- tummy (abdomen)
pelvis
Your doctor feels for any areas that are swollen or might not feel normal. They might also do a pelvic examination.
Pelvic examination
A pelvic examination is also called a:
- pelvic exam
- vaginal examination
- internal examination
To have this test, you usually lie down with your knees up and legs apart. You may be asked to rest your legs on padded leg supports.
Your doctor uses a to gently open your vagina. They look at the vagina and cervix to see if there is anything abnormal. Your doctor may use a strong light and magnifier.
They may also put two gloved fingers into your vagina. Then they press down on your abdomen at the same time with their other hand. They feel for any lumps or abnormalities. Your doctor may also check your rectum (back passage). They can feel for any lumps or changes in size or shape.
Some people find a physical examination uncomfortable and embarrassing. Your GP or specialist will try to make you as comfortable as possible.
You can ask for someone else to be in the room with you if you want, to act as a chaperone. A chaperone is a trained health professional such as a nurse. A friend or relative can also stay with you for support and comfort. They can be with you during the test or examination.
Blood tests
Blood tests can check your general health including:
- how well your liver and kidneys are working
- the number of blood cells such as
platelets and red blood cells
You usually also have a blood test to check the levels of a protein called CA125.
CA125 blood test
CA125 is a protein that circulates in the blood. It can be measured with a blood test.
Most women have a low level of CA125 in their blood. It might be raised in women with some types of ovarian cancer. You may hear doctors calling CA125 a type of tumour marker.
CA125 is not a completely reliable test for ovarian cancer. Some women with ovarian cancer will have a normal CA125 level. Some non cancerous conditions of the womb and ovaries can also raise the levels of CA125. This includes:
endometriosis fibroids pelvic inflammatory disease - pregnancy
The CA125 test shows that there is inflammation around the pelvis. But it can’t tell what is causing the inflammation.
If your level is high, your GP will arrange for you to have an ultrasound scan.
Ultrasound scan
Depending on the results of your CA125 test, your GP might arrange for you to have an ultrasound scan. You usually have this at your local hospital or community clinic.
Ultrasound scans use high frequency sound waves to create a picture of the:
- ovaries
- womb
- surrounding structures
The ultrasound scanner has a probe that gives off sound waves. The sound waves bounce off the organs inside your body, and the probe picks them up. The probe links to a computer that turns the sound waves into a picture on the screen.
You usually have an ultrasound scan of the lower part of your abdomen. This is an external ultrasound. This is when the doctor or a specialist healthcare professional called a sonographer moves the ultrasound probe over your skin.
You may also have a vaginal ultrasound scan. This is when your doctor or sonographer gently puts an ultrasound probe into your vagina. A vaginal ultrasound is also called an internal ultrasound or transvaginal ultrasound (TVS).
Tests your specialist might do
Depending on the results of your CA125 and ultrasound scan, your GP might refer you to a specialist at the hospital. This is usually a gynaecologist.
Your specialist usually uses a tool to help them decide if you need further tests. This tool is called the risk of malignancy index (RMI). The RMI looks at:
- the results of your ultrasound scan
- your CA125 level
- whether you have had the menopause
This gives doctors a score. Women with a high score are referred to a specialist . This is usually a gynaecological oncology MDT. They decide on which further tests you may need.
If it is unlikely that you have cancer, but they can’t completely rule it out, you may have an ultrasound scan 6 months later. They may also refer you to the gynaecological team for follow up and possibly treatment if you have an ovarian cyst.
Further tests
Your specialist may ask you to have more tests to find out for sure if you have ovarian cancer. These tests might include:
-
more blood tests
-
a CT scan
-
biopsy
Sometimes it is not possible to diagnose ovarian cancer without an operation.
Blood tests
Your specialist usually repeats the same blood tests done by your GP. This includes the CA125 level. They might also ask you to have a blood test to check the levels of:
-
alpha fetoprotein (AFP)
-
beta human chorionic gonadotrophin (beta hCG)
-
inhibin
-
lactate dehydrogenase (LDH)
These are tumour markers that are sometimes raised with some types of ovarian cancer. You may have these tumour markers tests if you are 40 years old or younger.
Your specialist may also check the levels of other tumour markers such as CEA and . These tumour markers are sometimes raised in people with different types of cancer that can spread to the ovaries.
CT scan
A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body. The computer puts them together to make a 3 dimensional (3D) image.
You usually have a CT scan of your chest, abdomen and pelvis. This helps to find out where the cancer is and whether it has spread (stage).
Taking a sample of tissue (biopsy)
A biopsy is the only way to find out for sure if you have ovarian cancer. Most people have a biopsy during an operation to look inside the abdomen and pelvis. This type of operation is called a laparotomy.
If you don’t have a laparotomy straight away, your doctor may suggest you have one of the following:
-
image guided biopsy
-
laparoscopy
-
removing a sample of abdominal fluid to check for cancer cells
Laparotomy
A laparotomy is an operation to look inside the abdomen and pelvis. You have a laparotomy under general anaesthetic. This means that you are asleep and won’t feel anything. You are usually in hospital for a couple of days.
To have a laparotomy, your surgeon makes a large cut down the middle of your abdomen. They look inside the abdomen and pelvis and take samples of tissue.
Sometimes, your surgeon can check during the operation if there are cancer cells. And if there are, they can continue with the operation to remove as much of the cancer as possible.
Image guided biopsy
An image guided biopsy means that your doctor uses a CT or ultrasound scan to guide where they put the needle and take the biopsy. You usually have an image guided biopsy in the CT or ultrasound scanning room.
Not all women can have an image guided biopsy. For example, you may not be able to have it if your cancer is in an area that is difficult to get to. In this case, you might have a laparoscopy instead.
You have a local anaesthetic injection in the skin over the area where your doctor puts the needle. This is so the area goes numb. Your doctor can take tissue samples from the ovaries and a sheet of fatty tissue inside the abdomen. This sheet of tissue is called the omentum. A specialist doctor called a pathologist looks at the tissue samples in the laboratory. They check for cancer cells.
You should get your results within 1 to 2 weeks. Contact the doctor who arranged the test if you haven’t heard anything after a couple of weeks.
Laparoscopy
A laparoscopy is a small operation to look inside your abdomen. You usually have it as a day case, so you can go home on the same day.
Your surgeon puts a thin tube with a light and a camera (laparoscope) through a small cut in your abdomen. They check the ovaries and the surrounding area and can take tissue samples if necessary. Your doctor sends the tissue samples to the laboratory to check for signs of cancer.
You have this operation under general anaesthetic. This means you are asleep and won’t feel anything.
Removing a sample of fluid from the abdomen or lungs
Sometimes ovarian cancer can cause fluid to build up in your abdomen or lungs. Fluid that builds up in your abdomen is called ascites. Fluid that collects around the lungs is called a pleural effusion. It can be a sign that your ovarian cancer has spread.
Your doctor might suggest taking a sample of fluid to check for cancer cells. You usually have this test in the outpatient department under local anaesthetic.
Your doctor puts a small needle in your abdomen or lungs to draw out some fluid. They send this fluid to the laboratory to check for cancer cells. If you have a lot of fluid, your doctor may drain some of it to relieve the pressure and make you more comfortable.
Tests on your ovarian cancer cells
After a laparotomy or biopsy, a sample of tissue is sent to the laboratory. A pathologist looks at the samples under a microscope. The results usually take about 2 to 4 weeks.
The pathologist does various tests on the sample. The tests can:
- help diagnose ovarian cancer
- show which type of ovarian cancer you have
- look at whether you have a fault (mutation) in certain
genes . If you have these gene mutations, you might be able to have a type of treatment called a PARP inhibitor.
Other tests you may have
You may also have other tests if doctors suspect that your cancer has spread to other parts of the body. The tests you may have include:
PET-CT scan - MRI scan
Your doctor can tell you which tests you need.
Treatment
The tests you have help your doctor find out if you have ovarian cancer and how far it has grown. This is the stage of the cancer.
This is important because doctors recommend your treatment according to the stage of the cancer.
Coping with ovarian cancer
Cancer affects people in different ways. Coping with a diagnosis of ovarian cancer can be difficult for some people.
