Know The Symptoms
One of the things that makes ovarian cancer tricky, is that the symptoms are ones that people can experience from time to time. Things like:
- Eating less and feeling fuller
- Abdominal/pelvic/back pain
- Needing to pee more or urgently
- Changes in bowel habits
- Abnormal vaginal bleeding* or discharge
- Pain during intercourse
- Unexplained weight change
So how do you know if it's something you need to pay attention to?
We call it the TWO WEEK RULE. If it hasn't gone away for good after two weeks - you should tell a doctor. Even one symptom is enough to mention. Especially if it's a new change, or unusual for you, or getting worse.
Most of the time, it won’t be ovarian cancer but it’s really important to get checked, because the quicker ovarian cancer is found, the easier it is to treat.
*Abnormal bleeding should always be checked regardless of duration
Cervical/Pap Smears Do Not Check For Ovarian Cancer
There is no screening test for ovarian cancer. That means people of average risk only need to get tested if they have symptoms.
What to expect at a doctor's appointment?
The doctor should take a thorough history. You should mention:
- What symptom(s) you have noticed
- When the symptom(s) started
- How often the symptom(s) happen and how long they last
- Whether the symptoms have caused you to alter your regular routine (for example if you have had to stop an activity because of fatigue or think twice about visiting places where you will not have easy access to a toilet)
- Any other changes that you’ve noticed (even if they are not the ones on our symptoms checker)
- If there is a family history of cancer (especially breast, ovarian and bowel cancer) - this could be on either your mother or father’s side
Quick tips for doctors visits
- It can be helpful to write notes of everything you want to talk to the doctor about in advance and take it with you.
- Some people find it helpful to keep a diary of their symptoms to show their doctor.
- If you are worried about being rushed you can ask for extra time when you make the appointment.
- If you feel like you are not being heard, you could take a friend for moral support.
The Three Types Of Tests For Ovarian Cancer
If a doctor thinks there is even a small chance the symptoms might be due to ovarian cancer there are three types of tests they can do
Your doctor might ask to do a physical examination called a pelvic exam. During a pelvic exam the doctor will ask to insert two gloved and lubricated fingers into your vagina, while they use their other hand to press on your stomach.
You can ask for a nurse or support person to be present during the examination.
A normal pelvic exam does not rule out ovarian cancer, but if the doctor feels any abnormal changes they may order other tests more urgently.
Your doctor might order a CA-125 blood test. This checks for a protein which can be raised in ovarian cancer.
CA-125 can also be raised by other conditions which are not cancer, and levels can sometimes be normal even if someone has ovarian cancer. This is more likely if the cancer is early, or the person is younger.
This is usually an ultrasound (trans-vaginal) but sometimes a Computerised Tomography (CT) scan or Magnetic Resonance Imagining (MRI) scan is used instead.
Imaging is very good at finding ovarian cancer - but not every change is cancer; and occasionally scans can be normal if the cancer is diffuse (spread thinly instead of in a lump), which is why it is important to let a doctor know if your symptoms continue or get worse.
If You Feel Like Your Concerns Are Not Being Taken Seriously
It’s not uncommon for people with ovarian cancer to tell us they had to visit the doctor multiple times before they were tested, or even get a second, or third, or forth opinion.
Don’t hesitate to tell a doctor if your symptoms get worse, or to see someone else if you feel your concerns are not adequately addressed.
You are not 'ovary-acting'.
Possible Test Results
All The Tests Are Normal
If both the blood test and imaging are normal, ovarian cancer is unlikely but you should let your doctor know if your symptoms continue, or change.
If your symptoms continue, your doctor might recheck your CA-125 level 4 to 12 weeks later. This helps find rare cases that are missed on initial testing.
If you develop new symptoms in the future be sure to let your doctor know.
One Or More Tests Is Abnormal
If either the blood test or imaging or both are abnormal you may or may not have ovarian cancer. Depending on the results your doctor may repeat tests, or refer you to a gynaecologist or a gynaecological oncologist (a specialist gynaecological cancer surgeon) for further investigation.
Ovarian Cancer Diagnosis
The only way to definitively diagnose ovarian cancer is with surgery or a biopsy. If you need surgery to investigate - outcomes are better for people with ovarian cancer when that surgery is performed by a gynaecological cancer specialist called a gynae-oncologist.
A Note On Family History
If you have a family history of breast, ovarian, prostate and/or pancreatic cancer it is worth asking your doctor about whether you should have genetic testing to see if you are at increased risk of ovarian cancer.
Most people with ovarian cancer do not have a family history - but certain inheritable mutations can increase the lifetime risk of ovarian cancer by up to 44%.
If you are at higher risk, there may be treatment which could significantly reduce your risk. Or your doctor may recommend monitoring (this varies by country).