Ovarian cancer: symptoms and diagnosis
The early symptoms of ovarian cancer are vague. They can be caused by other problems, so it is very difficult for you or your doctor to suspect they are due to ovarian cancer. Sometimes ovarian cancer is found unexpectedly during an operation such as a hysterectomy.
Symptoms
Symptoms of ovarian cancer can include a feeling of discomfort in the abdomen or a bloated feeling or pressure. There may be a change in bowel habits and flatulence (wind). Indigestion is also common and sometimes there can be problems with the kidneys or bladder. Some women have abnormal vaginal bleeding. Occasionally pain may be the first sign of ovarian cancer.
As the tumour grows, your abdomen can become quite enlarged. This is caused by the tumour itself or sometimes by a build-up of fluid (known as ascites). Ascites develops in response to the tumour in the abdomen. Loss of weight may also occur in spite of having an enlarged abdomen.
There is currently no effective way to detect ovarian cancer early. Unfortunately, the Pap test is only effective for the early detection of cancer of the cervix. Much research is being carried out to look at new ways to find ovarian cancer early. Many women feel angry or upset that their illness was not discovered earlier. You may even feel guilty that you did not go to a doctor sooner. It is quite normal to have these feelings and it may help you to talk about them with your doctor or nurse.
Testing for ovarian cancer
If ovarian cancer is suspected or has been diagnosed, you will need to be referred to a gynaecologist who specialises in treating women with ovarian cancer—a gynaecological-oncologist. Your specialist will arrange for you to have a number of tests and examinations. These tests help the doctor decide whether your symptoms are due to ovarian cancer or other causes.
Physical examination
This will include an internal pelvic examination where the doctor checks for a mass or lump in the lower abdomen.
Blood tests
Blood can be tested for a particular protein, or a tumour marker, called CA 125. This protein is often higher than normal in women with ovarian cancer. Some women may have other tumour markers called 'inhibin' or 'CEA'. The type of marker depends on the type of tumour. However, some tumours will not have any of these tumour markers.
Testing your blood for these tumour markers is one way to help diagnose cancer. These tests are also used later on to check the progress of your illness. Other blood tests may be also taken to help with your diagnosis and to check the effects of treatment.
X-ray and other imaging tests
Routine chest and abdominal X-rays may be taken.
Ultrasound scans are very important in the diagnosis of ovarian cancer. These are done in 2 ways. You may have an abdominal scan, where 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, which 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.
You may also have an X-ray of your bowel to make sure that your symptoms are not due to a bowel problem. This X-ray is called a barium enema, which is not painful but can be rather uncomfortable. With a barium enema, special fluid is inserted into your bowel through your back passage (rectum) and X-rays are then taken.
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 your surgery.
The stages of ovarian cancer
Like all cancers, ovarian cancer can spread to other parts of the body. However, ovarian cancer tends to spread within the abdominal and pelvic cavities rather than to more distant parts of the body. As the tumour grows larger, tumour nodules or seeds can invade other organs near the ovaries. These include the bowel, appendix, bladder, omentum (a protective membrane of fatty tissue which covers the abdominal organs), diaphragm, lymph nodes and liver.
If the ovarian cancer you have is confined to the ovaries or is very close to the ovaries, it may be called stage I or II. If it has spread to other organs it may be stage III or IV. Knowing the stage of the disease helps your doctor discuss treatment choices with you.
Last Reviewed: 20 April 2001
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