Because the symptoms are often negligible and easy to dismiss, ovarian cancer can be one of those stealth illnesses that goes unnoticed until it’s reached a late stage. After all, who hasn’t felt overly full on occasion? Or needed to urinate a little more often than normal? Because most (not all) cases occur in menopausal women, the bloating, pelvic pain, and other symptoms may seem unremarkable when so many other things are going on within a woman’s reproductive organs. No wonder the average delay between symptoms and diagnosis is approximately nine months.
If you’ve noticed that one or more symptoms keeps recurring for over a week, or if you also have a history of cancer in your family, your physician should test you for ovarian cancer. Here’s what to expect from your workup:Read More
Physical Exam: Once you’re done talking, your doctor will examine you. Along with all the normal measurements—blood pressure, weight, etc.—they will most likely perform a pelvic exam. This should include a recto-vaginal exam so the doctor can feel the tissue behind the uterus where the ovaries are often found.
Imaging: In order for the physician to get a better picture of what’s happening, you will probably be advised to get a trans-vaginal ultrasound. Depending on what the doctor has ordered, the imaging office may ask you to show up with an empty bladder, a full bladder, or somewhere in between.
Once you’re in the examining room, the doctor or sonographer will insert a transducer (a wand-like instrument), into your vagina. Depending on how full your bladder is, this may be mildly annoying or fairly uncomfortable, but any discomfort will disappear once the exam is over.
The sonographer will move the wand around, causing sound waves to bounce off your organs. These echoes form images that are transmitted onto a video screen so the person performing the exam can see them in real time. If a doctor is performing the ultrasound, you can get the results immediately, but if a sonographer is doing it, you will need to wait for a radiologist to interpret them. Unlike an x-ray, a sonogram will not expose you to any radiation.
There’s also a chance your doctor will want to do more in-depth imaging and prescribe a CT scan. This x-ray makes highly detailed cross-sectional images of your body and can show your physician whether or not the disease, if present, has spread to other organs or if the lymph nodes are enlarged. The CT scan isn’t used in place of a biopsy, because it often misses very small tumors. It can show larger tumors and illustrate whether or not the disease has migrated to other organs.
Blood Test: Your doctor may also take blood as part of the exam. The CA-125 blood test is a barometer for many of ovarian cancers, but it’s not a screening test. According to Dr. Beth Karlan, Gynecologic Oncologist at UCLA Medical Center, “even in stage one, the earliest ovarian cancers, CA-125 is normal in over half the cases, so we’re missing a lot of the cases by just checking the blood test.” But if your physician suspects you might have ovarian cancer, this test can be very helpful and should be done in the beginning so your oncologist can monitor the progression of the disease and the impact any treatments have on it.