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Ovarian Cancer: Diagnosis, Screening & Checks

The testing and diagnosis of ovarian cancer can be difficult. Unfortunately, ovarian cancer is often diagnosed in later stages, once symptoms have become more prominent.  But there are a range of tests and screening that can be done to help diagnose ovarian cancer.

Why is ovarian cancer so difficult to screen for?

Ovarian cancer can be difficult to detect in its early stages, due to many of its symptoms being associated with other, much less serious conditions such as irritable bowel syndrome. If left undiagnosed and untreated, however, ovarian cancer can become more serious over time.

How is ovarian cancer diagnosed?

If you have any of the four main symptoms of ovarian cancer (persistent stomach pain, persistent bloating, needing to wee more frequently or urgently, difficulty eating or feeling full more quickly), your GP should refer you for a CA125 blood test to check the level of a protein called CA125 in your blood.

Your GP will undertake an examination of your tummy and/or internal vaginal examination before they make this referral. The CA125 test can either be carried out at your local doctor’s surgery, or you will be referred to your local hospital the same way you would for any other blood test.

Tests that can help diagnose ovarian cancer

There is no national screening for ovarian cancer in the UK. This is because there isn’t a single test that reliably picks up ovarian cancer at an early stage.

However, a blood test and a scan can be used to try and determine if cancer cells are present in the ovaries. But other tests are often needed to effectively diagnose the disease.

Blood tests

A125 is a protein that both women and men have in their blood. A high level of CA125 in your blood is a possible indicator of ovarian cancer, as CA125 can sometimes be produced by ovarian cancer cells. A CA125 blood test is used to check the level of the CA125 protein in the blood to support the diagnosis of several things including ovarian cancer.

The CA125 test can either be carried out at your local doctor’s surgery, or you will be referred to your local hospital the same way you would for any other blood test. Read more about CA125 blood tests and understanding your results here.

Ultrasounds

If your CA125 levels are elevated, your GP will refer to the radiology department of your local hospital for an ultrasound scan. There are two types of ultrasound scan which can help with a possible diagnosis of ovarian cancer: abdominal and pelvic/transvaginal.

Understand more about your how ultrasounds can detect ovarian cancer and how to intepret your results here.

CT scans

A CT scan is a test that takes detailed pictures of the inside of your body. In the case of ovarian cancer, a CT scan may be recommended to find out if symptoms you have been experiencing are caused by something more serious.

A CT scan usually takes place in a hospital and is carried out by a healthcare professional called a radiographer. The process usually takes between 10-20 minutes.

Fine-needle biopsy

A fine needle biopsy is where the doctor passes a fine needle through the skin using a CT or ultrasound (see above) to guide them into the right place. This process allows them to remove a small sample of cells or fluid from your ovaries to review the tissue under a microscope and run other tests on the cells in the sample.

Laparoscopy

A laparoscopy (otherwise known as keyhole surgery) biopsy is done under general anaesthetic. The surgeon makes 3 or 4 small cuts about 1cm long in your lower tummy to look at your ovaries using a camera on the end of a tube (the larascope). The process allows the surgeon to examine the area carefully and take biopsies.

Laparotomy

Another option to detect ovarian cancer could be to have an operation called a laparotomy to get a biopsy. The surgeon uses one larger cut to open the lower abdominal to remove tissue or possibly your ovaries. This is only done if you and your doctor have discussed it and you have agreed to the operation beforehand.

Pelvic exams

In a pelvic examination, a doctor will press gently on different parts of the outside of your abdomen to feel for any masses or lumps. Most early ovarian tumors are difficult or impossible to feel though, Pelvic exams may, however, help find other cancers or female conditions.

X-ray

X-rays are rarely used in first diagnosing ovarian cancer, but they are sometimes used to see if cancer has spread elsewhere in the body. A chest x-ray can display tumors in the lungs, and fluid that has collected near the lungs, known as pleural effusion.

Detecting ovarian cancer early

Detection for ovarian cancer starts by seeing your GP if you are affected by any of the four key symptoms. Your GP will examine you and might refer you for tests or to see a specialist.

You should see your doctor if you notice a change that isn't normal for you. Or if you have any of the possible signs and symptoms of cancer.  The symptom might not be due to cancer. But if it is, the earlier it's picked up the higher the chance of successful treatment. 

How self-examining can help 

Keep a record of the symptoms you are experiencing and have your notes to hand when you speak to your doctor, to help them make a diagnosis.

At what stage is ovarian cancer usually diagnosed?

More than 75% of affected women are diagnosed at an advanced stage because early-stage disease is usually asymptomatic, and symptoms of late-stage disease are nonspecific.

Ovarian cancer is diagnosed at one of four stages. The stage describes big a cancer is and how far the cancer has spread inside the body – the higher the stage the further the cancer has progressed.

At what age are people with ovarian cancer usually diagnosed?

The risk of developing ovarian cancer increases with age, with more than half of all cases in the UK in women aged 65 and over. While older females are more likely to be diagnosed with ovarian cancer, younger females can develop it too.

You may have a higher chance of getting ovarian cancer if you:

  • Inherited a faulty gene, such as BRCA genes or those linked to Lynch syndrome (see below)
  • Had breast cancer or bowel cancer
  • Had radiotherapy treatment for a previous cancer
  • Have endometriosis or diabetes
  • Started your periods at a young age or went through the menopause late (over 55), or have not had a baby – because these factors may mean you’ve released more eggs (ovulate more)
  • Have never used any hormonal contraception, such as the pill or an implant
  • Are taking hormone replacement therapy (HRT)
  • Are overweight
  • Smoke

It’s still possible to get ovarian cancer even if you’ve had your ovaries removed. This is because ovarian cancer can also affect your fallopian tubes, or the lining inside your tummy (peritoneum).

Genetic testing and ovarian cancer

If you have used our risk tool and suspect your family history puts you at increased risk of cancer, we strongly recommend that you make an appointment to see your GP to discuss your situation further. You can read more on what to expect at the GP, the genetics clinic and managing the possible results of testing here.

Misdiagnosis of ovarian cancer

Other chronic conditions including irritable bowel syndrome and the menopause share symptoms with ovarian cancer such as bloating. This crossover means that there is a real danger of misdiagnosing the disease and often a far more serious diagnosis is overlooked.

FAQ'S

Can a smear test detect ovarian cancer?

No, a smear test does not check for ovarian cancer. The only gynaecologic cancer a smear test screens for is cervical cancer. There is still no national screening programme for ovarian cancer in the UK.

I’ve just been diagnosed with ovarian cancer, now what?

If you've been told you have ovarian cancer, you usually need more tests. These, along with the tests you've already had, will help the specialists find out the size of the cancer and how far it's spread (called the stage) to help inform the best course of treatment for you.