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Further tests for ovarian cancer

Women discussing ovarian cancer

This page tells you about the further tests you may have for ovarian cancer. You can find the following information

 

A quick guide to what's on this page

Further tests for ovarian cancer

It may not be possible to diagnose ovarian cancer until after you have had an operation. If your earlier tests suggest you have ovarian cancer, your specialist may ask you to have further tests before surgery. These are to see how far the cancer has grown, and whether it has spread. The results will help your doctor decide on the best possible treatment for you.

If you have a swollen abdomen from a build up of fluid, your doctor may take a sample of the fluid to check for cancer cells. After a local anaesthetic to numb your skin, the doctor puts a thin needle in to draw off some fluid. This goes to the laboratory for examination under a microscope.

Your doctor may suggest taking tissue samples (biopsies) from your ovaries or the sheet of fatty tissue inside your abdomen (the omentum). Your doctor will use a CT scan or ultrasound to help guide the needle through the skin to take the sample. This is called an image guided biopsy. You will have a local anaesthetic. You may have samples taken from different places, so you may have several needle puncture sites. You often have this test done as an outpatient.

If you are unable to have an image guided biopsy, your doctor may want to look inside your abdomen using a camera on a tube instead.  This is called a laparoscopy. It allows the doctor to examine your ovaries and the surrounding area. You have a short general anaesthetic. The doctor passes the tube through a small cut in your abdomen, looks for any signs of cancer and takes tissue samples if necessary.

If there is a high chance that you have ovarian cancer, or you are unable to have a laparoscopy, you may have an operation called a laparotomy. The surgeon makes a large cut into your abdomen so that they can examine the inside of your abdomen and pelvis. They take samples to check for cancer. These may be looked at by a pathologist during your operation. If cancer cells are found, the surgeon may continue to remove as much of the cancer as possible. They will only do this part of the operation if you agreed to it before surgery.

If you feel anxious waiting for test results, it may help to talk to your clinical nurse specialist, or a close friend or relative about how you are feeling. Or you may want to contact a cancer support group to talk to someone who has been through a similar experience.
 

CR PDF Icon You can view and print the quick guides for all the pages in the diagnosing ovarian cancer section.

 

 

Why you need these tests

After a first diagnosis of cancer, it is usual to have more tests. These are to see how far the cancer has grown, and whether it has spread. This is called staging. 

With ovarian cancer, it is not always possible to diagnose the exact type until after you have had surgery. The surgeon will get tissue samples during the operation. These will be closely examined in the lab.

As well as giving more information about how far the cancer has grown, the test results will help your specialist to decide on the best treatment for you.  You will not have all the tests mentioned here. Which ones you have will depend on your symptoms, and on the tests you have had so far.

 

Chest X-ray and scans

A chest X-ray will check for any sign of cancer spread to your lungs or fluid build up around the lung (a pleural effusion). 

A CT scan or ultrasound scan will check for any signs of cancer elsewhere in your tummy (abdomen). 

You may have an MRI scan, but this is not always necessary.

 

Image guided biopsy

You may have tissue samples (biopsies) taken from your ovaries or from a sheet of fatty tissue inside the abdomen. This sheet is called the omentum. Ovarian cancer can sometimes spread there.

Image guided biopsy uses a scan to guide where to put the needle. This test may be guided by CT or by ultrasound scan. You have the test done in the scanning room. You will have a local anaesthetic. The procedure takes about 10 to 20 minutes. Tissue samples are taken from part of the ovary or omentum. You may have samples taken from different places, so you may have several needle puncture sites. The tissue samples are examined in the lab to check for cancer. 

After the test, you will rest in bed for a while and your pulse and blood pressure will be monitored. If all seems well, you can get up and eat and drink normally within a few hours. You can have this done as an out patient or you may stay overnight in hospital. It will depend on how well you are and on the time of day you have the test done.

An image guided biopsy is not suitable for all women, for example if your tumour is in an area that is difficult to get to. In this situation you may have a laparoscopy instead.

 

Laparoscopy

This test uses a small camera to see inside the body. A laparoscopy is done in hospital under a short general anaesthetic. It examines your ovaries and the surrounding area without you having to have a big operation. The laparoscopy camera and a light are contained inside a thin, flexible tube.

The doctor makes a small cut, about half an inch long, in your abdomen. They put the tube through the cut and into the abdominal cavity. A small amount of carbon dioxide gas is pumped inside. This makes it easier to see and examine you thoroughly.

Usually, biopsies will be taken and sent to the laboratory to be examined for cancer cells. It is also possible to remove the ovaries with keyhole surgery, rather than having an operation with a large cut in your tummy. If you have your ovaries removed, they will be sent to the laboratory to be examined for signs of cancer.

When the examination is finished, the tube is taken out and a few stitches are used to close the cut. The stitches stay in for about a week. You will be able to get up as soon as the anaesthetic has worn off. The carbon dioxide gas may make you feel bloated and uncomfortable at first, but it will gradually disappear over a couple of days.

 

Laparotomy

A laparotomy is done under general anaesthetic. The surgeon makes a large cut down the middle of your abdomen so they can examine the inside of your abdomen and pelvis. They take samples of tissue and fluid to check for cancer. Sometimes a pathologist will look at these samples while you are still under anaesthetic. If cancer cells are found, the surgeon may continue with the operation to remove as much of the cancer as possible. They will only do this part of the operation if you already agreed to this before surgery. 

There is more information about surgery for ovarian cancer in the section about treating ovarian cancer.

 

Removing abdominal fluid

If you have a swollen abdomen, this may be due to fluid build up. Fluid build up in the abdomen is called ascites. It can be a sign of ovarian cancer that has spread. It can also be caused by other conditions that are not cancer. Your specialist will want to take a sample of fluid to check for cancer cells.

Diagram showing fluid (ascites) being drained from the abdomen

You may have this test in the outpatients department. First, you have a local anaesthetic injection into the skin of your abdomen. Once the skin is numb, your doctor puts in a needle to draw out some of the fluid. The fluid then goes to the laboratory to be examined for cancer cells.

If you have a lot of fluid, your doctor may want to drain it to relieve pressure in your abdomen and make you more comfortable. This is called an abdominal tap or abdominal paracentesis (para-sent-ee-sis).

Read more about ascites.

 

After your tests

When your test results have come through, your doctor will probably want you to come back to the hospital to discuss them. Getting results is bound to take a little time. You may feel very anxious while you are waiting. It may help to talk to your clinical nurse specialist, or a close friend or relative about how you are feeling. 

You could also contact a cancer support group to talk to someone who has been through a similar experience. Look at our list of ovarian cancer organisations. Some of them can help put you in touch with a support group. There is also a list of counselling organisations. They can help you to find emotional support and counselling in your area.

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Updated: 31 March 2016