Page last updated: May 2024
The information on this webpage was adapted from Understanding Ovarian Cancer - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in May 2024.
Expert content reviewers:
This information was developed based on Australian and international clinical practice guidelines, and with the help of a range of health professionals and people affected by ovarian cancer:
- Dr Antonia Jones, Gynaecological Oncologist, The Royal Women’s Hospital and Mercy Hospital for Women, VIC
- Dr George Au-Yeung, Medical Oncologist, Peter MacCallum Centre, VIC
- Dr David Chang, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC
- Prof Anna DeFazio AM, Sydney West Chair of Translational Cancer Research, The University of Sydney, Director, Centre for Cancer Research, The Westmead Institute for Medical Research and Director, Sydney Cancer Partners, NSW
- Ian Dennis. Consumer (Carer)
- A/Prof Simon Hyde, Head of Gynaecological Oncology, Mercy Hospital for Women, VIC
- Carmel McCarthy, Consumer
- Quintina Reyes, Clinical Nurse Consultant – Gynaecological Oncology, Westmead Hospital, NSW
- Deb Roffe, 13 11 20 Consultant, Cancer Council SA.
If your doctor suspects you have ovarian cancer, they will usually start with a pelvic examination, and then order some tests and scans. The only way to confirm ovarian cancer is through a biopsy, usually done during surgery.
At the same time, samples of fluid in the abdomen may also be taken and examined. Many masses found on the ovaries will not be cancer. A diagnosis can only be made after tissue or fluid has been sampled and the cells checked by a pathologist.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for ovarian cancer can help you make sense of what should happen.
It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
Pelvic examination
In a pelvic examination, the doctor will press gently on the outside of your abdomen (belly) to feel for any masses or lumps.
To check your uterus and ovaries, the doctor will place two gloved fingers into your vagina while pressing on your abdomen with their other hand. You may also have an examination using an instrument that gently separates the walls of the vagina.
A pelvic examination is not painful but it may be uncomfortable. You can ask for a staff member, family member or friend to be present during the examination.
The doctor may also perform a digital rectal examination, placing a gloved finger into the rectum through the anus. This lets the doctor feel the tissue behind the uterus where cancer cells may grow.
Blood tests
You may have blood tests to check for proteins produced by cancer cells. These proteins are called tumour markers. The most common tumour marker for ovarian cancer is CA125.
The level of CA125 may be higher in some cases of ovarian cancer. It can also rise for reasons other than cancer, including:
- ovulation
- menstruation
- irritable bowel syndrome
- some infections such as pneumonia or appendicitis
- liver or kidney disease
- endometriosis, or
- fibroids.
The CA125 blood test is not used to screen for ovarian cancer if you do not have any symptoms. It can be used:
- At diagnosis – A CA125 test is more accurate in diagnosing ovarian cancer if you have been through menopause. If you have early-stage ovarian cancer, CA125 levels are often normal. This is why doctors will often combine CA125 tests with an ultrasound.
- During treatment – For ovarian cancer that produces CA125, the blood test may be one way to check how well treatment is working.
- After treatment – CA125 blood tests are sometimes included in follow-up tests.
There is currently no effective screening test for ovarian cancer. The cervical screening test (which replaced the Pap test in 2017) looks for human papillomavirus (HPV). This virus causes most cases of cervical cancer but it does not cause ovarian cancer. Neither the cervical screening test nor the Pap test can help find ovarian cancer.
Imaging scans
Your doctor may recommend a number of imaging scans to look for a pelvic mass or lump, and to see how big it is. You will need further tests to diagnose any mass as cancer.
Types of imaging scans
Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast during previous scans. You should also let them know if you have diabetes or kidney disease, or are pregnant or breastfeeding.
Pelvic ultrasound
A pelvic ultrasound uses soundwaves to create a picture of your uterus and ovaries. The soundwaves echo when they meet something dense, such as an organ or tumour and a computer creates a picture from the echoes.
A technician called a sonographer does the scan. A pelvic ultrasound appointment usually takes 15–30 minutes.
A pelvic ultrasound can be done in 2 ways:
- Abdominal ultrasound – To get clear pictures of the uterus and ovaries, the bladder needs to be full, so you will be asked to drink water before the appointment. You will lie on an examination table while the sonographer moves a small handheld device called a transducer over your abdomen.
- Transvaginal ultrasound – The sonographer inserts a small transducer wand into your vagina. The wand will be covered with a disposable plastic cover and gel to make it easier to insert. You may find a transvaginal ultrasound uncomfortable, but it should not be painful. If you feel embarrassed or concerned about having this procedure, you can ask for a female sonographer or to have someone in the room with you (e.g. your partner, a friend or a relative).
The transvaginal ultrasound is often the preferred method of ultrasound because it provides a clearer picture of both the ovaries and uterus.
CT scan
A CT (computerised tomography) scan uses x-rays to create a detailed picture of the inside of the body. A CT scan can be used to check your abdomen, chest and pelvic area, look for signs the cancer has spread, and assist in guiding the needle if doing a biopsy.
The CT scanner is a large, doughnut-shaped machine. You will lie on a table that moves in and out of the scanner. CT scans are usually done at a hospital or radiology clinic. You will be asked to fast (not eat or drink) before the scan.
You may need to have an injection of a special dye, called contrast, which makes your organs appear white in the pictures so anything unusual can be seen more clearly. A CT scan is noisy but painless.
The contrast will be injected into a vein. It may make you feel hot all over, have a sudden urge to pass urine, and leave a bitter taste in your mouth. These sensations usually pass quickly, but tell the person carrying out the scan if they don’t.
The scan takes about 10–20 minutes, but it may take extra time to prepare. You usually go home as soon as the CT scan is over.
MRI scan
An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to build up detailed pictures of the inside of your body.
While not used often to diagnose ovarian cancer, an MRI may help if it is difficult to tell from the ultrasound whether an ovarian tumour is likely to be cancerous. A contrast may also be used with an MRI.
If you have a pacemaker, let the medical team know before having an MRI. The magnet can interfere with some pacemakers.
During the scan, you will lie on a bench inside a large metal tube that is open at both ends. The noisy, narrow machine makes some people feel anxious or claustrophobic. If you think you may become distressed, mention it beforehand to your medical team.
The MRI scan may take between 30 and 90 minutes.
PET–CT scan
A PET (positron emission tomography) scan combined with a CT scan is a specialised imaging test. It provides more information about the cancer than a CT scan on its own. Only some people will have a PET–CT scan.
Medicare covers the cost only for ovarian cancer that has returned, so these scans are not often used to look for ovarian cancer in the first instance. If you are having chemotherapy before surgery, you may have this scan beforehand.
To prepare for a PET–CT scan, you will be asked to fast (not eat or drink) for a period of time. Before the scan, you will be injected with a glucose solution containing a small amount of radioactive material.
Cancer cells show up brighter on the scan because they take up more glucose than normal cells do. You will be asked to sit for 30–90 minutes as the glucose spreads through your body, then you will have the scan.
The scan itself will take about 30 minutes. Any radiation will leave your body within a few hours.
Genetic testing after diagnosis
If you are diagnosed with epithelial ovarian cancer, your treatment team will probably suggest genetic testing. This is a blood test that looks for a fault in the BRCA1, BRCA2 or another similar gene.
This test may be available through the public hospital system at no cost, or Medicare may cover some of the costs. The results will help work out if the ovarian cancer may respond to treatments such as targeted therapy.
Genetic counselling is always offered with genetic testing so you can make an informed decision.
If a cancer-related gene fault is found, Medicare may also cover the cost of testing close adult female and male relatives to check their risk. Men can inherit and pass on BRCA faults and may have a higher risk of prostate cancer.
These genetic faults, or mutations, may also increase the risk of other cancers including breast, bowel and uterine cancers.
Learn more about genetic testing
Taking a biopsy
The only way to confirm the diagnosis of ovarian cancer is to remove a sample of tissue from the tumour, or to drain fluid from the abdomen or chest if fluid is present.
This is sent to a specialist called a pathologist who checks it under a microscope for cancer cells.
Depending on the characteristics of the cancer, your treatment team will recommend the best way to collect the sample, such as:
- surgical biopsy – samples are taken during surgery to remove the mass
- image-guided biopsy – involves removing tissue using a fine needle. The doctor will use a CT scan to guide the needle through skin which has been numbed by a local anaesthetic, into the mass
- fluid sample – fluid, called ascites, is collected in a similar way as an image-guided biopsy, using a fine needle that is guided through the skin during a CT scan. This is a cytology test.
Molecular tests on the sample
If ovarian cancer is found, the biopsy sample or the tissue removed during surgery will usually have more tests.
Called molecular tests, these look for gene changes (mutations) and other features in the cancer cells that may help predict the cancer’s response to targeted therapy.
These gene changes are similar to those passed through families, however, for some people with ovarian cancer, the fault is only in the cancer cells. Molecular testing is recommended in most cases if you have high-grade ovarian cancer.
These tests may include HRD testing. HRD stands for homologous recombination deficiency, which is a characteristic of some cancer cells that makes it harder for them to fix or repair damaged DNA.
Testing your samples for HRD can help work out if targeted therapy can be part of your treatment. Medicare subsidies are available for some testing. Your doctor or family cancer clinic will be able to provide more information.
Your treatment team will use the results of molecular testing to help them work out what treatment may work best for you, and what treatment may not be as effective.
Staging ovarian cancer
Once ovarian cancer is diagnosed, it will be staged. This process helps your health care team recommend the best treatment for you.
The staging system most commonly used for ovarian cancer is the International Federation of Gynecology and Obstetrics (FIGO) system.
This system divides ovarian cancer into four stages, which may also be divided into sub-stages, such as A, B, C, which indicate increasing amounts of tumour.
Stages 1–2 mean it is early ovarian cancer. Stages 3–4 mean the cancer is advanced. About 7 out of 10 cases of epithelial ovarian cancer are diagnosed at stage 3 or 4.
Grading ovarian cancer
Some types of ovarian cancer will be given a grade. This is a score that describes how the cancer cells look compared with normal cells under a microscope. The grade suggests how quickly the cancer may grow.
Epithelial ovarian cancer is simply divided into low grade and high grade and a number is not given. The most common type of ovarian cancer is high-grade serous cancer.
Sometimes, numbers between 1 and 3 are assigned to other types of ovarian cancers.
Prognosis
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for anyone to predict the exact course of the disease.
To work out your prognosis, your doctor will consider:
- test results
- the type of ovarian cancer, its stage and grade
- genetic factors
- likelihood of response to treatment
- factors such as your age, fitness and overall health.
If epithelial ovarian cancer is diagnosed and treated when the cancer is inside the ovary (stage 1), it has a good prognosis.
Many cases of more advanced cancer may respond well to treatment, but the cancer can often come back (recur) and further treatment is needed.
Stromal cell and germ cell tumours can usually be treated successfully, although there may be a small risk the cancer will come back and need further treatment. Borderline tumours can usually be treated successfully with surgery alone.
Discussing your prognosis can be challenging and stressful. It may help to talk with family and friends, or call our cancer nurses on 13 11 20.
