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Ovarian cancer tests

Women discussing ovarian cancer

This page gives information about the tests used to diagnose ovarian cancer. There is information about

 

A quick guide to what's on this page

Ovarian cancer tests

You will usually see your family doctor first, who will ask you about your general health and examine you. Your GP will ask about any symptoms you have had. They may take a blood sample to send away for testing. They may want to examine you internally to see if your womb and ovaries feel abnormal in any way. If there is any cause for concern, your GP may arrange for you to have an ultrasound. They may then refer you to a gynaecologist at your local hospital.

At the hospital

The specialist will ask you about your medical history and symptoms. They will then examine you. You may have another internal examination. If your specialist is concerned that you may have ovarian cancer, they will arrange some tests. You are likely to have a blood test for CA125 and an ultrasound first of all, if you have not already had them. You may also have a CT scan. There is information about each of these tests further down the page. 

While you are waiting for results, it may help to talk to 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 similar experiences.
 

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

 

 

Seeing your GP

Usually, you begin by seeing your family doctor who will ask you about your general health and gently feel your tummy (abdomen). You will be asked about any symptoms you have. Your GP may do an internal examination. They may also take a blood sample, which can be sent away for testing for CA125. Your doctor may then refer you for an ultrasound scan.

 

Internal examination

Your GP may want to examine you internally to see if your womb and ovaries feel normal. You can ask for a female doctor to do this if you prefer. The doctor will ask you to lie on your back on the couch with your feet drawn up and your knees apart. They will then put one or two gloved fingers into your vagina at the same time as pressing down on your tummy (abdomen) with their other hand. They may be able to feel if there are any swellings or lumps in your ovaries or womb.

Your doctor may then put a speculum into the vagina to see if your cervix looks normal. This examination shouldn't take more than 5 minutes at most.

Your doctor may then refer you to a gynaecologist at your local hospital.

 

At the hospital

The specialist will begin by asking you about your medical history and symptoms. They will then examine you. You may have another internal examination. If your specialist is concerned that you may have ovarian cancer, they will arrange some tests. You are likely to have a blood test for CA125 and an ultrasound scan, if you have not already had them. 

You may also have other scans, such as a CT scan. If any of these tests suggest you may have ovarian cancer, your specialist may want to do further tests before you have surgery.

 

CA125 blood test

CA125 is a protein produced by some ovarian cancers. It circulates in the blood and so can be measured with a blood test. Some other conditions of the womb and ovaries also produce CA125, such as

  • Endometriosis
  • Fibroids
  • Pelvic inflammatory disease
  • Pregnancy

So CA125 is not a completely reliable test for ovarian cancer.  It shows that there is some kind of inflammation in the area of the body surrounded by the hip bones (the pelvis).  But it cannot tell the doctor exactly what is causing the inflammation.

Most women have a low level of CA125 in their blood.  If your level is high, it is a sign that there is some kind of problem and you will need to have further tests. 

The CA125 blood level is raised in about half the women who have early stage ovarian cancer. Around 9 out of 10 women (90%) with more advanced ovarian cancer have raised CA125 levels.

If you are found to have ovarian cancer that produces CA125, this blood test can be used to monitor how well your treatment is working.

 

Ultrasound

This may be an abdominal ultrasound or a transvaginal ultrasound. Both types of ultrasound test may be used to help diagnose ovarian cancer. It can help to show whether

  • The ovaries are the right size
  • The ovaries look normal in texture
  • There are any cysts in the ovaries

Transvaginal ultrasound can help to show whether any cysts on your ovaries contain cancer or not. If a cyst has any solid areas it is more likely to be cancer.

Sometimes, in women who are past their menopause, the ovaries do not show up on an ultrasound. This means that the ovaries are small and not likely to be cancerous.

If you have a suspicious looking cyst, your specialist will recommend that you have surgery to remove it. This may be because it is large and you are past your menopause. Or because there is a sign that it may contain cancer cells. The cyst will be looked at closely in the laboratory.

To decide if an abnormality is more likely to be cancer or not, doctors can use a tool called the risk of malignancy index (RMI). This index combines the results of the ultrasound, CA125 blood levels and menopausal status (whether or not you are past the menopause). This gives doctors a final score. Women with a high score are referred to a specialist multidisciplinary team who will decide on which further tests and surgery may be necessary.

Your specialist may ask you to have a CT scan to show the ovaries more clearly. Sometimes though, it is not possible to diagnose ovarian cancer for certain without an operation.

If your specialist thinks it unlikely that you have cancer, but cannot completely rule it out, they may ask you to come back for a repeat ultrasound scan in 3 months time, to see if anything has changed.

 

CT scan

This is a type of X-ray that takes pictures from different angles. The pictures are fed into a computer to form a detailed picture of the inside of your body. Your doctor uses the scan to get a detailed picture of the ovaries and surrounding areas. Before a CT scan you may be asked

  • Not to eat or drink for 4 hours before the test
  • To drink a special liquid a few hours before the test
  • To drink more of the liquid in the X-ray department

The liquid is called a contrast medium. It helps to show up body structures more clearly on the scan. You may have the contrast as an injection into a vein. The radiology department at your hospital will give you specific instructions about what to do before your scan. You will need to let them know if you have asthma or any allergies. There is more about having a CT scan in the section about cancer tests.

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Updated: 25 January 2014