Diagnosing ovarian cancer

Tests

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, in which a sample of tissue is taken to be examined under a microscope. The biopsy is 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. The diagnosis of ovarian cancer can only be made after tissue or fluid has been sampled and the cells checked by a specialist called a pathologist.

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.

For more information, listen to Cancer Council's podcast episode Genetic Tests and Cancer, and visit Ovarian Cancer Australia to order their booklet on genetic testing.

Staging and grading

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. Stages 1–2 are early ovarian cancer, while 3–4 are advanced. About 7 out of 10 cases of epithelial ovarian cancer are diagnosed at stage 3 or 4.

Stages of ovarian cancer

The 4 stages of ovarian cancer in the FIGO system may be divided into sub-stages, such as A, B, C, which indicate increasing amounts of tumour.

Stage 1  – cancer is in one or both ovaries or fallopian tubes only.

Stage 2 – cancer is in one or both ovaries or fallopian tubes and has spread to other organs in the pelvis (uterus, bladder or bowel).

Stage 3 – cancer is in one or both ovaries or fallopian tubes and has spread outside the pelvis to the lining of the abdomen (peritoneum) or nearby lymph nodes.

Stage 4 – cancer has spread outside the abdomen to distant organs such as the lungs or liver.

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 epithelial 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.

For your prognosis, your doctor will consider:

• test results
• the ovarian cancer type, its stage and grade
• genetic factors
• likelihood of response to treatment
• factors such as your age, fitness and overall health.

Epithelial cancer – If epithelial ovarian cancer is diagnosed and treated when the cancer is only in the ovary (stage 1), it has a good prognosis. Many cases of more advanced cancer may respond well to the initial treatment, but the cancer can often come back (recur) and further treatment is needed.

Stromal cell and germ cell tumours – These can usually be treated successfully, although there may be a small risk that the cancer will come back and need further treatment.

Borderline tumour – This can often be treated successfully with surgery alone.

Discussing your prognosis can be challenging and stressful. It may help to talk with family and friends. You can also call Cancer Connect on 13 11 20.

Listen to Cancer Council's podcast episode Coping with a Cancer Diagnosis.