Women's Health Matters

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Ovarian cancer often has no symptoms (or only very mild ones) until it begins to spread beyond the ovaries. Unfortunately, there is no effective way of screening for ovarian cancer at this time. The effective treatment of ovarian cancer will be significantly increased if researchers can develop a screening test that helps doctors identify ovarian cancer at its early stages. Several large studies are currently underway, but the results will not be available for several years.

Physical symptoms of ovarian cancer include:

  • abdominal discomfort or pelvic pain
  • bloating
  • difficulty eating or feeling full quickly
  • frequent urination
  • fatigue
  • backache
  • nausea, indigestion, loss of appetite
  • weight loss
  • change in bowel habits
  • gas
  • pain during intercourse
  • abnormal vaginal bleeding (rare)

These symptoms are associated with a variety of health concerns, many of which are not serious. However, any woman who experiences any combination of these symptoms for more than three weeks should contact her family doctor and consider having the following tests:

  • a bimanual rectovaginal examination
  • a transvaginal ultrasound
  • a CA-125 blood test (postmenopausal women only)

A bimanual rectovaginal exam
A bimanual rectovaginal exam involves a doctor inserting one finger into the vagina and another into the rectum, to feel for any lumps around the ovaries.

Transvaginal ultrasound
An ultrasound uses sound waves to create a picture of the inside of the body. During a transvaginal ultrasound, a probe is placed inside the vagina to take 'pictures.' The images can be seen on a video monitor and may also be printed out.

A transvaginal ultrasound can help spot abnormal growths on the ovary, and if abnormalities are present, it may help to distinguish between a tumour and a cyst. The test is painless and can be completed very quickly. You do not need to drink water for this test.

CA-125 test
CA-125 is a protein which is normally found in the body, but which is often produced at higher levels by tumour cells. Most women with Stage-3 or Stage-4 ovarian cancer have elevated levels of CA-125. A blood test can measure your level of CA-125.

A CA-125 test has several limitations. It is not effective for detecting ovarian cancer in its early stages, as only 40 to 50 percent of women with Stage-1 ovarian cancer have elevated levels of CA-125. Another limitation is that many women who have elevated levels of CA-125 do not have ovarian cancer at all. Elevated CA-125 levels can also be caused by a number of other conditions, many of which are benign. These include endometriosis, pelvic inflammatory disease, fibroids, benign tumours, pregnancy and other conditions.

If abnormalities are found during any of these tests, further tests should be done, as none of these initial tests can prove you have cancer. To distinguish between a malignant growth and a benign tumour or cyst, followup diagnostic tests are needed.

If your doctor suspects that you may have ovarian cancer, ask for a referral to a gynecological oncologist.

Diagnostic Tests for Ovarian Cancer

Imaging technologies, such as CT scans or radiographic scans, may be used to define the size, location of and changes to any abnormal growths that may be found on the ovaries. However, surgery is the only sure way to determine whether a cancer is present.

Laparoscopy vs. Laparotomy

Sometimes this initial surgical examination may be done using an instrument called a laparoscope. A laparoscope is a telescope with a tiny camera mounted on the end. This instrument can be inserted through a small incision just below your belly button, to look inside your abdomen. If necessary, it can also be used to remove tissue. The use of a laparoscope is not appropriate for everyone, and not all surgeons are comfortable with this type of surgery.

Your physician may recommend a more extensive surgery called a laparotomy. During a laparotomy, the abdominal wall is opened through a large incision and the surgeon can do a more extensive resection of other abdominal organs. If an initial laparoscopic exam does reveal cancer tissue, a subsequent laparotomy may be necessary.

During either of these exploratory procedures, the doctor will examine the ovaries and other abdominal organs for abnormal growths. This will allow the surgeon to determine the stage of the cancer. The surgeon will also remove tissue to examine later under a microscope. If one of the ovaries appears abnormal, the surgeon will remove the entire affected ovary and possibly both ovaries. Removing only a portion of the ovary might risk leaving cancerous cells in the ovary.

Surgical Treatment

If you are having a laparotomy, your doctor will discuss with you before the surgery what will happen if cancer is found. The first step in cancer treatment is to remove the affected organs. This may be done during the initial surgery to reduce the need for further surgery. Use our Treatment pages to learn more.

Staging Ovarian Cancer

Staging is the process of assessing whether the cancer has spread and how far it has spread. The stage of your cancer, along with the general state of your health and whether or not you plan to have children, will help determine the treatment best for you. Staging is done by combining information from imaging tests with the results of a surgical exam done during a laparotomy.

Numbered stages are used to describe the extent of the cancer and whether it has spread (metastasized) to more distant organs. Generally, there are four stages used to describe the extent of ovarian cancer.

Stage I: The disease is limited to the ovary.

Stage II: The cancer has spread beyond the ovaries, but is limited to the pelvis (below the navel). This may include the uterus, fallopian tubes, bladder, sigmoid colon or rectum.

Stage III: The cancer has spread beyond the ovaries, but is limited to the pelvis and abdominal cavity (excluding the liver). This may include the lining of the abdomen and the lymph nodes in the abdomen.

Stage IV: The cancer has spread to the liver or organs outside the abdomen.


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  • A publication of:
  • Women's College Hospital