Ovarian Cancer
Diagnosis and Staging

This page covers tests that are often used to help diagnose and stage ovarian cancer.
Depending on the symptoms you have, you may also be asked to undergo other tests and investigations.

“You can be a victim of cancer, or a survivor of cancer. It’s a mindset.” 

Dave Pelzer 

Diagnostic Tests to Determine Cancer Type

Once the doctor is sure of an abnormality, a biopsy is done to determine further details about the type of cancer present.

Biopsy

What to expect

A biopsy is usually the best way to tell for certain if an abnormal area is cancerous or not. This procedure involves collecting a sample of tissue for further analysis in a lab. In most cases, a biopsy is needed before any treatment starts. While the screening tests for ovarian cancer are generally painless, a biopsy can cause discomfort, bleeding or even pain. There are generally two types of biopsies used to diagnose ovarian cancers

Image-guided biopsy
In this method, the doctor will pass a fine needle through the skin, using a CT or ultrasound scan to guide them to the right place. Your doctor will normally use local anaesthesia to complete this procedure. You may also be given a mild sedative to help you relax. You will usually be kept under observation for a few hours after this test, or sometimes overnight.

Laparoscopy
This is a surgical procedure used to take biopsies. You will be given a general anaesthetic (i.e. you will be asleep) during the operation. The doctor will make a few small cuts in the abdomen. Then he or she will pump gas into the abdominal wall, to gain better visibility of the internal organs. Next, your doctor will pass a thin tube with a small camera at one end into the abdomen. This instrument is called a laparoscope. The doctor will then examine the area carefully and take biopsies. You may experience some pain or discomfort after the procedure, but this will usually subside after a day or two. You will usually be kept under observation for a few hours after this test, or sometimes overnight.

Diagnostic Tests to Determine
Stage and Spread of Cancer

Bone Scan

What to expect

A bone scan is a type of imaging study and is generally painless. During the scan, an image of the bones is taken. It is typically more sensitive than an X-ray. It is important that you choose a doctor and clinical team that you are comfortable with to perform scan.

You may be asked to refrain from eating or drinking for a few hours before your scan. Be sure to inform your doctor prior to your scan if

You are pregnant or breastfeeding

You have previously had an allergic
reaction to contrast material

You are taking any vitamins, ayurvedic
medicines or homeopathic medicines

During a bone scan:

You may be asked to change into a hospital gown and remove your jewellery, watch, body piercings or any other accessory that contains metal. You may also be asked to empty your bladder.

You may be given a special dye (called contrast material) which can help highlight the bones of your body. The dye is typically administered by injection through a vein in your arm. You may need to wait for a few hours for your body to absorb the dye. Your doctor may ask you to drink plenty of fluids while you wait.

Next, a nurse or technician will take you to the room which contains the bone scanner. You will be asked to lie on a narrow table. The nursing staff may use straps to keep you in position. You can ask for a pillow if you are feeling uncomfortable. You will be asked to remain still for the duration of the scan.

During the scan, a device that has a sensitive camera will pass back and forth over your body.

The technicians will be seated in a separate room, but they will be able to see and hear you. You may be asked to communicate with them via intercom. They may ask you to hold your breath at certain times to improve image quality.

The scan will usually take 30 minutes to an hour to complete.

After the scan, you may receive special instructions regarding the contrast material. For example, your technician or doctor may ask you to wait for a few minutes to ensure that you do not have an allergic reaction. You may also be told to drink plenty of fluids to help your kidneys flush out the contrast material through your urine.

CT Scan

What to expect

A CT (computerized tomography) scan is an imaging study and is generally painless. It uses X-rays to take multiple images of the body from different angles to recreate three-dimensional pictures of your internal organs on a computer. It is important that you choose a doctor and clinical team that you are comfortable with to perform your CT scan.

You may be asked to refrain from eating or drinking for a few hours before your scan. Be sure to inform your doctor prior to your scan if

You are pregnant or breastfeeding

You have any metal or electronic
devices implanted in your body (such
as a pacemaker or metal pins)

You are afraid of enclosed spaces
(claustrophobic)

You have previously had an allergic
reaction to contrast material

You are taking any vitamins, ayurvedic
medicines or homeopathic medicines

During a CT scan

You may be asked to change into a hospital gown and remove your jewellery, watch, body piercings or any other accessory that contains metal. You may also be asked to empty your bladder.

You may be given a special dye (called contrast material) which can help highlight the areas of your body that are being examined. The dye can be given to you by mouth (in a drink), by injection through a vein in your arm or by an enema in your rectum. You may need to wait for 30 minutes to an hour for your body to absorb the dye.

Next, a nurse or technician will take you to the room which contains the CT scanner. You will be asked to lie on a narrow, motorized table that will slide you into the machine. The nursing staff may use straps to keep you in position. You can ask for a pillow if you are feeling uncomfortable. You will be asked to remain still for the duration of the scan.

As the table moves you into the CT scanner, various detectors and X-ray tubes will rotate around you. Each rotation will produce several cross-section images of your body. You may hear some buzzing or whirring noises – try not to be alarmed and remember to stay still.

The technicians will be seated in a separate room, but they will be able to see and hear you. You may be asked to communicate with them via intercom. They may ask you to hold your breath at certain times to improve image quality.

The scan will usually take 20-30 minutes to complete.

After the scan, you may receive special instructions regarding the contrast material. For example, your technician or doctor may ask you to wait for a few minutes to ensure that you do not have an allergic reaction. You may also be told to drink plenty of fluids to help your kidneys to flush out the contrast material through your urine.

PET Scan

What to expect

PET (Positron emission tomography) scan is a process that uses radioactive glucose to detect malignant tumour cells in the body. Malignant tumour cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. The scan is generally painless. It is important that you choose a doctor and clinical team that you are comfortable with to perform your PET scan. Some hospitals have a combined PET/CT scanner.

You may be asked to refrain from eating or drinking for a few hours before your scan. Be sure to inform your doctor prior to your scan if:

You are pregnant or breastfeeding

You have any metal or electronic
devices implanted in your body (such
as a pacemaker or metal pins)

You are afraid of enclosed spaces
(claustrophobic)

You have previously had an allergic
reaction to contrast material

You are taking any vitamins, ayurvedic
medicines or homeopathic medicines

During a PET scan:

You may be asked to change into a hospital gown and remove your jewellery, watch, body piercings or any other accessory that contains metal. You may also be asked to empty your bladder.

You may be given a special dye (called contrast material) which can help highlight the areas of your body that are being examined. The dye can be given to you by mouth (in a drink), by injection through a vein in your arm or by an enema in your rectum. You may need to wait for 30 minutes to an hour for your body to absorb the dye.

Next, a nurse or technician will take you to the room which contains the PET scanner. You will be asked to lie on a narrow, motorized table that will slide you into the scanner. The nursing staff may use straps to keep you in position. You can ask for a pillow if you are feeling uncomfortable. You will be asked to remain still for the duration of the scan.

As the table moves you into the PET scanner, the machine will begin to rotate around you. Each rotation will produce several cross-section images of your body. You may hear some buzzing or whirring noises – try not to be alarmed and remember to stay still.

The technicians will be seated in a separate room, but they will be able to see and hear you. You may be asked to communicate with them via intercom.

The scan will usually take about 30 minutes to an hour to complete.

After the scan, you may receive special instructions regarding the contrast material. For example, your technician or doctor may ask you to wait for a few minutes to ensure that you do not have an allergic reaction. You may also be told to drink plenty of fluids to help your kidneys to flush out the contrast material through your urine.

MRI Scan

What to expect

Magnetic resonance imaging (MRI) scan is a procedure in which an MRI scanner uses a high-powered magnet and a computer for comprehensive images of the internal organs and surrounding structures. MRI scans normally add supplementary information about anomalies in the stomach and may be recommended only in select cases. The scan is generally painless. It is important that you choose a doctor and clinical team that you are comfortable with to perform your MRI scan.

You may be asked to refrain from eating or drinking for a few hours before your scan. Be sure to inform your doctor prior to your scan if:

You are pregnant or breastfeeding

You have any metal or electronic
devices implanted in your body (such
as a pacemaker or metal pins)

You are afraid of enclosed spaces
(claustrophobic)

You have previously had an allergic
reaction to contrast material

You are taking any vitamins, ayurvedic
medicines or homeopathic medicines

During a MRI scan:

You may be asked to change into a hospital gown and remove your jewellery, watch, body piercings or any other accessory that contains metal. You may also be asked to empty your bladder.

You may be given a special dye (called contrast material) which can help highlight the areas of your body that are being examined. The dye is typically administered by injection through a vein in your arm. You may need to wait for 30 minutes to an hour for your body to absorb the dye.

Next, a nurse or technician will take you to the room which contains the MRI machine. You will be asked to lie on a narrow, motorized table that will slide you into the machine. The nursing staff may use straps to keep you in position. You can ask for a pillow if you are feeling uncomfortable. You will be asked to remain still for the duration of the scan.

As the table moves you into the MRI machine, the machine creates a strong magnetic field around you and radio waves are directed at your body. You may hear repetitive noises such as thumping or tapping – try not to be alarmed and remember to stay still. You can request earplugs or have music playing to help you block out the noise.

The technicians will be seated in a separate room, but they will be able to see and hear you. You may be asked to communicate with them via intercom.

The scan will usually take about 30 minutes to an hour to complete.

After the scan, you may receive special instructions regarding the contrast material. For example, your technician or doctor may ask you to wait for a few minutes to ensure that you do not have an allergic reaction. You may also be told to drink plenty of fluids to help your kidneys to flush out the contrast material through your urine.
How Ovarian cancer is staged

The results of your diagnostic tests will help your doctor determine the size and position of the cancer, and whether it has spread. This is called staging. Knowing the stage and grade of your cancer will help your doctor plan the best course of treatment for you. 

Typically, the number staging system is used for describing the stage of ovarian cancer. Ovarian cancer is divided into four number stages.

Stage I Ovarian cancer is when cancer cells are found in one or both ovaries or the fallopian tubes. Stage 1 cancers are further divided into stages 1A, 1B and 1C, depending on the size of the tumour and the deepest point of tumour invasion.

Stage II ovarian cancer is when cancer cells are found in one or both ovaries or the fallopian tubes and have spread into other areas of the pelvis. Stage 2 ovarian cancers are further divided into stages 2A and 2B, depending on the size of the tumour and how far the cancer has spread.

Stage III ovarian cancer is when cancer cells are found in one or both ovaries or the fallopian tubes and have spread into other areas of the pelvis, abdomen or nearby lymph nodes. Stage 3 ovarian cancers are further divided into stages 3A, 3B and 3C depending on the size of the tumour and how far the cancer has spread.

Stage IV ovarian cancer is also called metastatic ovarian cancer. This is when the cancer has spread from the pelvic area to other parts of the body, such as the bladder, rectum, bones, the liver or lungs.

Treatment options for ovarian cancer

Treatment for ovarian cancer depends on several factors, like the type and stage of your cancer, or other health problems you may have. Surgery, chemotherapy, radiation, or a combination of all three may be used. Refer to this section to understand the types of cancer treatments and their effects. Read more

Your cancer journey

Everyone deals with ovarian cancer diagnosis and treatment in a different way. Refer to this section, to understand
various aspects of your cancer journey and the road to recovery. Read more

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