Ovarian Cancer
Tests and investigations for ovarian cancer
Ian Jacobs, a professor of gynaecological oncology explains the tests used to diagnose ovarian cancer and assess its spread. These tests include an examination of the abdomen both externally and internally (vaginally and sometimes rectally), CA125 blood tests ('Treatment outcomes and follow-up'), and ultrasound scans. These scans use sound waves to make up a picture of the inside of the abdomen. This may be done by spreading a gel on the abdomen and passing a device over it, or by inserting a small device (about the size of a tampon) into the vagina.
A Doctor describes the various tests used to diagnose and assess the spread of ovarian cancer.
A Doctor describes the various tests used to diagnose and assess the spread of ovarian cancer.
Those tests can either be, sometimes they'd be requested by the general practitioner, in other situations the GP would refer the patient into hospital and may be requested through the hospital. If the ultrasound scan and the CA125 suggest that there is an ovarian cancer present, sometimes no further investigations will be required, and in some instances it will be possible to go on to treatment just on the basis of the examination, the CA125 and the ultrasound. That treatment would normally be surgery in the first instance. In other situations, the CA125 and ultrasound may be uncertain or unclear, or more information may be needed before proceeding to treatment.
And then more sophisticated investigations may be performed, like a body scan, a CT scan, or an MR scan. They can give more information, not only about the condition of the ovaries, but also about the rest of the abdomen and pelvis, and give information about whether or not the cancer has spread outside the ovary.
Women may also have one of several other types of scan such as CT or magnetic resonance imaging (MRI). Some have exploratory surgery or biopsies taken. If there is fluid in the abdomen (ascites) it may be drained both to relieve symptoms and to look for cancer cells.
Some women we interviewed presented with an abdominal lump which their doctor suspected was a cyst or fibroid. Such lumps need further investigation and possibly biopsy and/or surgical removal to show whether they are benign or malignant. One woman had various diagnostic tests that confirmed her doctor's suspicion of an ovarian cyst that would need removal.
Went into hospital with a suspected ovarian cyst and describes the tests she had.
Went into hospital with a suspected ovarian cyst and describes the tests she had.
He asked if he could examine me vaginally and rectally to really, just to sort of confirm what he thought. He did do and he was still of the same opinion. He said that I should go straight to our local hospital, be prepared to stay in, they would want to do some tests. And he phoned them so they expected me, and he wrote a covering letter.
One of my work colleagues took me over to the hospital, tried to contact my husband who was in a meeting so she left a message. Had quite a long wait but I was examined, I was admitted and over the next couple of days I had x-rays, blood tests, ultra-sound scans and they confirmed that yes, there was a large cyst on the left ovary and that it would have to be operated on.
Where a condition other than ovarian cancer was at first suspected, women had other tests such as colonoscopy, barium enema, urine tests, cervical screening tests and hysteroscopy before or at the same time as having an ultrasound scan that revealed their ovarian cancer.
Some women had tests done privately rather than in the NHS to shorten the wait or because they usually used private medical services.
Had a scan done privately because of a 6-8 week wait for an NHS scan.
Had a scan done privately because of a 6-8 week wait for an NHS scan.
Anyhow, the doctor referred me for an ultra-sound scan on my pelvic area, but I was told that this could probably take six to eight weeks. So discussing it with my husband and my family over that weekend we decided as a family that I should go private.
And on the Monday I rang the local private hospital and got a scan appointment for the Tuesday.
Most women with ovarian cancer already have advanced stage disease when they are diagnosed. This is because early stage ovarian cancer rarely produces symptoms, and because the symptoms of advanced disease are common and are usually caused by less serious conditions (see 'Symptoms'). Over the past decade much research has been done to see if screening well women using ultrasound scans and CA125 blood tests can detect ovarian cancer earlier and save lives. Some evidence already existed that these tests could detect the disease earlier, but our gynaecological oncologist, speaking in 2004, explains why screening has not yet been introduced and why a clinical trial involving many thousands of women was needed. The trial (United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) has now finished and the data analysed but further follow up of the women is needed before “firm conclusions can be reached”* about the benefits of screening.
Speaking in 2004, a doctor describes the aims of research into screening for ovarian cancer.
Speaking in 2004, a doctor describes the aims of research into screening for ovarian cancer.
Speaking in 2004, a doctor describes why screening has not yet been introduced despite some evidence that it can detect ovarian cancer earlier.
Speaking in 2004, a doctor describes why screening has not yet been introduced despite some evidence that it can detect ovarian cancer earlier.
Ovarian cancer is a relatively uncommon cancer, so that if we're not careful, for every woman picked up with these tests who has cancer, we will end up operating on many, many other women who don't have cancer, and some of those women will have complications, and in fact in some of the studies a small number of women who had false positive screening tests with CA125 or ultrasound have died from complications of surgery even though they did not have ovarian cancer. So we have to be very, very careful about that.
And the final reason for not offering screening immediately to everyone is that we haven't yet proved that picking the cancer up with the screening test earlier actually saves lives. Now some people say 'If you pick it up earlier surely it saves lives?' Well the answer is not necessarily. We could be picking it up early, but we may not be picking it up early enough to prevent the cancer spreading and to make the disease curable by the treatment that's available. So it's too early to offer this sort of screening to every woman in the population.
Speaking in 2004, a doctor explains why a clinical trial involving many thousands of women was set up.
Speaking in 2004, a doctor explains why a clinical trial involving many thousands of women was set up.
The UKCTOCS trial is designed so that recruitment is over 3 years and it's recruitment of 200,000 women, and 160,000 of them are recruited as of now in mid-2004. During the next year the remaining 40,000 will be recruited, so by 2005 all of the women will be participating in the study. The screening will then continue till 2010, and by 2011 or 12 we will have the mortality data, so we'll be able to see for the first time whether ovarian cancer screening really does save lives.
*Jacobs, I J., Menon, U., et al. (2015). Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial The Lancet : 10.1016/S0140-6736(15)01224-6
Last reviewed June 2016.
Last updated June 2016.
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