Ovarian cancer - Diagnosis 

Diagnosing ovarian cancer 

If you have any symptoms of ovarian cancer, it's important to see your GP as soon as possible.

Your GP will first ask about your symptoms, your general health and whether there is a history of ovarian or breast cancer in your family.

Your GP may also carry out a vaginal or internal examination to investigate your ovaries and womb. They may also take a blood sample or refer you for an ultrasound scan.

If necessary, your GP may then refer you to a specialist (a gynaecologist or gynaecological oncologist) at the hospital.

The specialist may carry out another internal examination. They will ask about your symptoms and general health. They may also do further tests to confirm the diagnosis of ovarian cancer, including a blood test and ultrasound.

Blood test (CA125)

You may have a blood test to look for a chemical called CA125 in the blood. This chemical is produced by some ovarian cancer cells. A very high level of CA125 in the blood may mean you have ovarian cancer.

However, this chemical is not specific to ovarian cancer and may also be raised in many benign conditions, so a raised level of CA125 does not definitely mean you have ovarian cancer.

The National Institute for Health and Care Excellence (NICE) has produced guidance that advises your GP to test for CA125 if you frequently experience: 

  • bloating
  • feeling full quickly
  • loss of appetite 
  • pelvic or abdominal pain 
  • needing to urinate urgently or frequently

Read the full NICE guidance on recognition and treatment of ovarian cancer (PDF, 302kb).

The CA125 test is particularly important if you are 50 or over, or have these symptoms more than 12 times each month.

If you experience unexplained weight loss, fatigue or changes in your bowel habits such as diarrhoea or constipation, your GP may also test for CA125.

If you are 50 or over and have experienced symptoms that could suggest irritable bowel syndrome (IBS) in the last 12 months, such as bloating, abdominal pain or changes in your bowel habits, your GP should test your CA125 level.

A significant proportion of women with early stage ovarian cancers have a normal CA125 level.

If you do have a raised CA125 level, your GP will arrange for you to have an ultrasound scan.

Ultrasound

Ultrasound uses high frequency sound waves to produce an image of your ovaries. You may have an internal ultrasound (known as a transvaginal ultrasound), where the ultrasound probe is inserted into your vagina, or you may have an external ultrasound, where the probe is put next to your stomach. The image produced can show the size and texture of your ovaries, as well as any cysts that may be present.

Further tests

If you've been diagnosed with ovarian cancer, you may have further tests to see how large the cancer is and whether it has spread. This is called staging.

These other tests may include:

  • chest X-ray – this can see if the ovarian cancer has spread to your lungs or caused a build-up of fluid around the lungs (called a pleural effusion).
  • CT scan or MRI scan these imaging techniques are used to look for signs of cancer elsewhere in your chest, abdomen and pelvis.
  • abdominal fluid aspiration – if there is a build-up of fluid in your abdomen and it looks swollen, it could mean your ovarian cancer has spread. To find out, a thin needle is passed into your abdomen to take a sample of fluid to be tested for cancer cells. 
  • laparoscopy this small operation may be performed if the gynaecologist wants to take a better look at the ovaries. A thin tube with a camera on the end (a laparoscope) is inserted through a small cut in your lower abdomen (stomach) in order to examine your ovaries. A small sample of tissue may be taken from your ovaries for testing (this is known as a biopsy).

Staging helps your doctors decide on the best kind of treatment for your condition. However, it is important to remember that the stage of your ovarian cancer alone cannot predict how your condition will progress.

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Stages and grades of ovarian cancer

Staging

When your ovarian cancer is diagnosed, the doctors will give it a stage. This is often based on surgical findings. The stage describes the size of the cancer and how far it has spread. Ovarian cancer has four commonly used stages:

  • stage 1 – the cancer only affects one or both of the ovaries
  • stage 2 – the cancer has spread from the ovary and into the pelvis or uterus
  • stage 3 – the cancer has spread to the lining of the abdomen, the surface of the bowel and the lymph nodes in the pelvis
  • stage 4 – the cancer has spread to other parts of the body such as the liver, spleen or lungs 

This is a simplified guide – each stage is divided into further categories called A, B and C. If you're not sure what stage you have, ask your doctor.

Grading

The grade of cancer refers to the appearance of cells under a microscope.

  • low grade – although abnormal, cells appear to be slow-growing
  • moderate grade – cells look more abnormal than low-grade cells
  • high grade – cells look very abnormal and are likely to be fast-growing

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Page last reviewed: 01/11/2012

Next review due: 01/11/2014

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