If you have been experiencing symptoms of ovarian cancer your GP will arrange a number of tests. The details of the pathway a GP will follow are available on the National Cancer Control Programme website.
These may include:
Physical examination:
The first thing your GP will want to do is take a look at your stomach area to feel for any lumps and bumps. They may also suggest an internal vaginal examination to see if there are any lumps around your womb or ovaries. These examinations will normally take place in your GP surgery.
Blood tests:
CA-125: This blood test determines if the level of CA-125, a protein produced by ovarian cancer cells, has increased in the blood of a woman at high risk for ovarian cancer or with an abnormal pelvic examination. While CA-125 is an important test, it unfortunately is not always accurate. Some non-cancerous diseases of the ovaries and non-ovarian diseases such as endometriosis, liver disease, inflammatory bowel disease also increase the CA-125 levels, and some ovarian cancers may not produce enough CA-125 levels to cause a positive test. Other blood tests sometimes used may include carcinoembryonic antigen (CEA), Beta-human chorionic gonadotropin (Beta-hCG), Alpha-fetoprotein (AFP).
Pelvic Ultrasound
A pelvic ultrasound scan is carried out at a hospital and produces a picture of the inside of your body and can help detect any abnormalities. A full bladder will be required for performing this test. There are two types of pelvic ultrasound:
Transabdominal ultrasound: A handheld device is passed back and forth over your stomach, producing images of your ovaries, womb and other internal organs
Transvaginal ultrasound: A probe is inserted into your vagina to obtain pictures of your womb, fallopian tubes and ovaries. The procedure is not painful but you may find it a little uncomfortable
When the results are negative- If your blood test is abnormal but nothing shows up on the ultrasound scan, your GP will check if anything else is causing your symptoms. If your GP can’t find a reason for your symptoms, he or she may give you medication to control them. If your symptoms get worse, or become more frequent, do not be afraid to go back to your GP and ask for another CA-125 blood test and ultrasound. do not ignore the symptoms and do not take no for an answer.
When the results are positive- These tests are most effective when used in combination. If these tests suggest that you may have ovarian cancer then you may be referred to a gynaecologist, they will arrange for you to have further hospital tests to confirm that this is the case. Doctors may also use X-Rays, MRIs, CT scans or biopsies as part of your diagnosis
Computerised tomography (CT) scan:
A CT scan is an X-ray that produces a picture of the inside of your body. CT scans can be used to spot tumours in your ovaries and elsewhere. A CT scan takes up to half an hour and staff will take time to explain what will happen and make you feel comfortable.
You will be asked to lie on a bed that passes you through the CT scanner. You may be asked to drink a special fluid called a contrast that helps the CT scanner to take clearer pictures of your body. You will also be asked to avoid eating food and drinking liquids a few hours before the scan.
Magnetic resonance imaging (MRI) scan:
An MRI scan uses magnetic fields and radio waves to produce an image of your internal organs. An MRI scan can take around 30 minutes. You will receive an appointment letter explaining the procedure and any requirements such as avoiding eating and drinking for a few hours before the scan.
You will need to tell the radiographers if you have a pacemaker, artificial heart valve or any other metal implant, like an artificial hip, or clipping of a brain aneurysm.
The MRI scanner can be noisy so if you’re prone to feeling claustrophobic make sure that you tell the staff as some hospitals can offer you headphones or earplugs and a sedative so that you feel comfortable with the procedure.
Removing fluid from the abdomen
Sometimes swelling or bloating in the tummy can be due to a build-up of fluid. This is called ascites and it can be caused by ovarian cancer or by other non-cancerous conditions. If you have ascites, your doctor may want to take a sample of fluid to check for cancer cells.
The doctor injects some local anaesthetic into the skin on your abdomen. Once the skin is numb they pass a small needle into the abdomen and draw some of the fluid into a syringe. The fluid is sent to the laboratory to be examined.
If you have a lot of fluid in your abdomen, the doctor may remove it to help you feel comfortable. This can be done in the outpatient clinic or as an inpatient. The doctor puts a fine tube called a cannula into the abdomen. They then attach the cannula to a drainage bag, which collects the fluid as it drains from the abdomen.
Image-guided biopsy
This test may be done if the results of the tests you’ve had strongly suggest that you have ovarian cancer and your treatment plan involves you having chemotherapy before surgery. It’s done so that a sample of the tumour can be tested to confirm that you have ovarian cancer and find out what type it is.
Before the test, the doctor numbs the skin using a local anaesthetic injection. You may also be given a sedative to help you relax. Then, using a CT or ultrasound scanner to guide them to the right place, the doctor passes a needle through the skin and into the tumour. They use the needle to remove a small sample of tissue (a biopsy) from the tumour. This is then sent to the laboratory for analysis.
You will need to stay in hospital for a couple of hours after a biopsy, and possibly overnight. This is because there’s a risk of bleeding afterwards. If you havebeen given sedation, you will need someone to take you home and to stay with you for 24 hours until the effects have completely worn off.
Laparoscopy
A laparoscopy is a type of surgical procedure where a surgeon can access the inside of the abdomen (tummy) and pelvis without making large incisions in the skin.
You should not eat or drink anything for eight hours before the procedure and you may be given medication to empty your bowels. A laparoscopy is carried out under general anaesthetic, so you will not feel any pain.
A flexible tube with a camera at the end of it is inserted through a small incision in your abdomen. The camera transmits images of your ovaries to a screen, which the surgeon can then analyse. After a laparoscopy the incisions are closed using stitches and a dressing applied.
You can often go home on the same day you have a laparoscopy, although sometimes you may need to stay overnight.
Laparotomy
A laparotomy is a type of surgical procedure where a surgeon makes a large incision in the abdomen.
To prepare for a laparotomy you will be asked not to eat or drink anything for eight hours before surgery and you may be given medication to empty your bowels.
A laparotomy is carried out under general anaesthetic so you will not feel any pain. This procedure allows a surgeon to remove anything growing on the ovary or sometimes the ovary itself.
Any tissue that is removed is sent to the laboratory to be tested for cancer.