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How do I know if my ovarian cancer has spread?

There is currently no proven screening test for ovarian cancer. If your doctor suspects you have ovarian cancer, you may have blood tests (CA125), and medical imaging scans (ultrasound, CT scan). These tests can show if there are any abnormalities that may be present and should be examined further (for example by performing a biopsy to get a tissue sample).

The only test to confirm if you have ovarian cancer is to take a tissue biopsy. This can be done by going to the operating theatre under general anaesthetic or take a biopsy through a needle in your belly and look at the cells under a microscope. Sometimes a needle to obtain tissue will not obtain enough cells and the procedure will need to be repeated after a week or two. Through a surgical procedure, generally the diagnosis can be confirmed and the cancer is treated together at the same time.

After a diagnosis of ovarian cancer doctors will determine if it has spread and how far. This process is called “staging”. 

Ovarian cancer stages range from stage I (1) through to IV (4). The lower the number indicates early stage disease. A higher number means cancer has spread more. Stages I–II mean that it is early ovarian cancer.

Stages III–IV mean the cancer is advanced. Each stage is further divided into sub-stages, such as A, B, C, which indicate increasing amounts of cancer.

Ovarian Cancer Staging

  • Stage I: Cancer is in one or both ovaries only.
  • Stage II: Cancer is in one or both ovaries and has spread to other organs in the pelvis (uterus, fallopian tubes, bladder or bowel).
  • Stage III: Cancer is in one or both ovaries and has spread beyond the pelvis to the lining of the abdomen (peritoneum) or to nearby lymph nodes.
  • Stage IV: The cancer has spread further to distant organs such as the liver or the chest.

The original stage of a cancer will never change, even later, when the cancer may have come back.

When diagnosed early at stage 1 before it has spread, most patients have an excellent prognosis.

Sometimes your surgeon will suggest a PET CT scan. PET CT is the medical imaging technology providing the highest resolution. Tumours as small as 6 mm can be picked up.

However, no scan is perfect. Sometimes cancer can grow in a confetti-style pattern, where small and thin particles of cancer are thinly spread throughout the inner lining of the belly. These cancers are challenging to visualise through any medical imaging and only a laparoscopy will identify them.

If the cancer has spread, this can obviously be concerning but does not need to be a sign to give up. In my practice we see many patients who had far spread tumours that have shrunk with neoadjuvant chemotherapy. Subsequent surgery then can render a patient disease-free.

Many of these women will eventually recur once or even twice; but many will have significant high-quality time they can spend.

Symptoms

Knowing the symptoms of ovarian cancer can help to obtain an early diagnosis, so you can present to a doctor if you notice any of the following:

  • Abdominal bloating
  • Feeling full quickly after eating a small amount
  • Unexplained weight loss
  • Discomfort or pain in the pelvis
  • Changes in bowel habits
  • Frequent urination.

However, ovarian cancer symptoms can be vague even in early stages. These symptoms can also be confused with other benign conditions such as irritable bowel syndrome, an upset stomach or bladder infections, however it is important to see a doctor if symptoms are out of the ordinary for you and persistent. In some cases, you may be asked to have a colonoscopy (a camera that looks inside your bowel) to exclude that your symptoms are caused by a bowel problem.

Read more about the diagnosis and treatment of Ovarian Cancer here.

If you are concerned about any of these symptoms and wish to discuss them with a Gynaecological Oncologist, please enquire about an appointment.

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