Ovarian cancer: symptoms and diagnosis
The early symptoms of ovarian cancer are vague and can include discomfort in the abdomen or a bloated feeling or pressure. There may be a change in bowel habits and flatulence (wind). Indigestion can also occur and sometimes problems with the kidneys or bladder. Some women have abnormal vaginal bleeding. Occasionally pain is the first sign of ovarian cancer.
Symptoms such as these can be due to other things, so ovarian cancer is not always suspected. Sometimes ovarian cancer is found unexpectedly, for example during a scan for other reasons.
As the cancer grows, your abdomen can become bigger. This is due to the cancer or a build-up of fluid called ascites, which is caused by the cancer. Women may also lose weight in spite of having a bigger abdomen.
There is no effective way to detect ovarian cancer early. The Pap test is very important for finding cancer of the cervix early, but it does not detect ovarian cancer.
Many women feel angry or upset that their cancer was not found earlier. You may even feel guilty that you did not go to a doctor sooner. It is quite normal to have these feelings. It may help you to talk about them with your doctor or nurse.
Researchers are looking for ways to find ovarian cancer early.
Doctors and other health professionals you may see
Your doctor will refer you for tests to see if you have cancer. If the tests show you have cancer or may have cancer, your doctor will refer you to a specialist, who will examine you and may ask you to have more tests.
If you have cancer, one or more specialists will advise you about treatment options.
You should expect to be cared for by a team of health professionals from the relevant major fields (see following list). Ideally, all your tests and treatment will be available at your hospital; however, this may not be possible. Health professionals who care for people with ovarian cancer include:
- gynaecological oncologists, who diagnose and treat women with ovarian cancer
- medical oncologists, who specialise in using chemotherapy to treat cancer
- radiation oncologists, who specialise in using radiotherapy to treat cancer
- surgeons, who are responsible for some biopsies and other surgical procedures
- dietitians, who will recommend the best diets to follow during and after treatment
- nurses and general practitioners, who will help you through all stages of your cancer
- social workers, psychologists, physiotherapists and occupational therapists, who will advise you on support services and help you to get back to normal activities.
How ovarian cancer is diagnosed
If ovarian cancer is suspected or has been diagnosed, you should be referred to a doctor who specialises in treating women with ovarian cancer, who is known as a gynaecological oncologist. Your specialist will arrange for you to have some tests and examinations. These tests help the doctor decide whether your symptoms are due to ovarian cancer or to other causes.
This will include an internal pelvic examination where the doctor checks for a mass or lump in the lower abdomen.
Your blood may be tested for tumour markers (for example, CA 125). These are proteins that are often higher than normal in women with ovarian cancer, because it is sometimes produced by ovarian cancer cells.
Testing blood for tumour markers is one way to help confirm a diagnosis of cancer in a woman with symptoms of ovarian cancer. These tests can be used later to check your progress.
Other blood tests may be done to help with diagnosis and check the effects of treatment.
You may have a colonoscopy of your bowel to make sure that your symptoms are not due to a bowel problem. The doctor will look at the large bowel using a thin flexible tube with a small camera and light at the end.
Computed tomography (CT) scan
A CT scan is a type of x-ray. It gives a cross-sectional picture of the organs and other structures (including any tumours) in your body.
CT scans are usually done at a hospital or a radiology clinic. It takes about 30 to 40 minutes to complete this painless test.
You will be asked not to eat or drink anything before the scan, except for a liquid dye. The dye makes your organs appear white on the scans that are taken, so anything unusual will show more clearly.
You will lie on a table while the CT scanner, which is large and round like a doughnut, moves around you. Most people are able to go home as soon as their scan is over. There is a small possibility of the injected dye causing an allergic reaction. You should tell your doctor if you are allergic to iodine or to contrast dyes, or if you are diabetic or have abnormal kidney function.
Magnetic resonance imaging (MRI)
This test is like a CT scan, but it uses magnetic fields instead of x-rays to build up pictures of the organs in your pelvic area, including your ovaries and other organs nearby.
MRI is painless, and the magnetism is harmless. You will lie still inside a large metal tube, which is open at both ends. The tube makes some people feel claustrophobic (afraid of being in a small space). You can usually take someone into the room with you to keep you company.
A probe may be placed in your vagina to get a better view of the ovaries. The test may take up to an hour. The machinery can be quite noisy.
If you have a metal device like a pacemaker or joint replacement you should not have an MRI. This test will help your doctor decide whether the cancer has spread beyond the ovaries. This will help you both decide which treatment is best for you.
Ultrasound scans are very important in the diagnosis of ovarian cancer.
They are done in two ways. In an abdominal scan, the ultrasound specialist passes a hand-held device called a transducer over your pelvic area. This is used to build up pictures of your organs. The pictures can be seen on a screen. You may also have a trans-vaginal ultrasound, where the transducer is inserted into your vagina. This is because the ovaries sometimes cannot be imaged by the abdominal ultrasound. Some women find the procedure a little embarrassing and uncomfortable, although it is not painful. Discuss the procedure with your doctor and ultrasound specialist if you have any concerns.
Positron emission tomography (PET) scan
Like other scans, PET scans can be used to look for abnormalities in tissues, particularly whether there might be cancer. It can give valuable extra information to the CT or MRI scans. You will be injected with a glucose solution containing a very small amount of radioactive material. You will lie on a table, which moves through a large, ring-shaped scanner. The scanner can ‘see' the radioactive material, which shows where the glucose is being used in the body. Cancer cells show up as areas where glucose is being used by actively growing cells.
This test can take up to two to three hours.
Unfortunately, none of these tests can definitely diagnose ovarian cancer. The only way this can be done is with an operation. This means that ovarian cancer is usually diagnosed and treated at the same time.
You need to make sure that you understand enough about your illness and the operation before you have surgery.