Screening for ovarian cancer

Symptoms of ovarian cancer can be vague and hard to spot, especially in the early stages. Many women put their symptoms down to other things or ignore them, which may lead to a delay in diagnosis and treatment.

Symptoms may include:

• Abdominal bloating
• Changes in your bowel habits
• Feeling full quickly after eating
• Loss of appetite
• Weight loss
• Pelvic pain or discomfort
• Back pain
• Fatigue
• Peeing more frequently than usual, or needing to pee urgently

At your first consultation with Circle Health Group, you will be seen by a consultant gynaecologist, a doctor specialising in conditions affecting the female reproductive system.

Your consultant will ask you about your symptoms and perform a physical examination. They will recommend a test for ovarian cancer depending on your symptoms and the results of any previous tests. There are many tests for ovarian cancer. Some are used to diagnose the condition and others to check the stage of your cancer and whether or not it has spread. A blood test and an ultrasound scan are normally the first tests recommended.

Ovarian cancer may be suspected from the results of your tests and scans, but in many cases a biopsy (tissue sample) is needed to diagnose ovarian cancer.

Why is this first consultation so important?

Your first consultation is where we get to know you, address any concerns and you may have. We can also discuss what your test results mean and what will happen going forward.

It is very important to us that you are as well-informed and comfortable as possible during your time with us, so please ask your consultant any questions you may have.

The ROCA® Test is a blood test that assesses your risk of having ovarian cancer. It uses something called the Risk of Ovarian Cancer Algorithm (ROCA) to calculate the extent to which you are at risk of developing the disease.

The test uses your levels of CA-125 along with other factors such as your age to give a more accurate picture. It is typically suitable for people between 35 and 85 years of age who have a known mutation in their BRCA1 or BRCA2 genes.

The ROCA® test results are divided into three categories: normal, intermediate or elevated. A normal score means you'll be advised to have another test after a year, while an intermediate score advises that you have a second test after three months.

However, if you have an elevated score, your Consultant will recommend a transvaginal ultrasound scan of your ovaries, an assessment and screening for CA125. If you have ovarian cancer, you may have higher levels of CA125 in your bloodstream. This can be detected through a blood test.

According to ROCA® and the National Institute for Health Research, the test can improve patients' survival rates and outcomes through identifying early-stage ovarian cancer.

If you have symptoms of ovarian cancer, a blood test called a CA 125 may be a marker that you have the disease.

The CA 125 is not a 100% reliable test for ovarian cancer as higher than normal levels indicate inflammation in the pelvic area but do not show the specific cause.

A high level of CA 125 may also be due to:

• Endometriosis
• Fibroids
• Pelvic inflammatory disease
• Pregnancy

A CA 125 test can also give a false negative result meaning you have ovarian cancer even though your result is negative. If you have a high level of CA 125 in your blood, your consultant will order further tests.

Your consultant may also order other blood tests to check your general health, how well your liver and kidneys are working and your levels of red and white blood cells.

What happens during a blood test?

Your blood will be taken by a doctor, nurse, or phlebotomist (someone specially trained to take blood). Let the person taking your blood know if you are nervous about the blood test, feel unwell, or are afraid of needles.

1. First, you will sit or lie down
2. Next, the person taking your blood will apply a tight band called a tourniquet around the top of your arm. They may ask you to make a fist. This makes it easier to find a vein
3. Your skin is cleaned, and a small needle is inserted into your vein
4. A thin tube and syringe or small bottles are attached to the needle and blood is drawn out
5. The tourniquet is released and the needle is removed. A piece of gauze or cotton wool will be pressed firmly on your arm for a few minutes

Possible risks and complications of blood tests

Blood tests are a safe and routine procedure and complications are unlikely but may include:

• Bleeding
• Bruising
• Swelling
• Dizziness or fainting
• Rarely, infection

An ultrasound scan uses high-frequency sound waves to create a detailed picture of a part of your body. To check for ovarian cancer you will have an abdominal ultrasound that may be done externally by moving the ultrasound probe over your lower tummy, or vaginally, by inserting the probe into your vagina.

An ultrasound can check:

• The size, shape, and texture of your ovaries
• If there are any cysts present and whether they are likely to be cancer

If you have a cyst on your ovaries that may be cancer, your consultant will recommend that you have it removed. The cyst can then be examined in a laboratory.

Preparing for your ultrasound

You will be given instructions on how to prepare in your appointment letter. Follow the instructions carefully and call the hospital if you have any questions.

If you are having an external ultrasound, you may need to stop eating for around six hours before your scan.

For some external ultrasounds, you need to have a full bladder so that your consultant can see the images clearly. If this is the case, drink plenty of water before your scan.

For a vaginal ultrasound, there is no special preparation. You can eat and drink normally. You will need to empty your bladder before your scan.

What happens during an ultrasound?

1. You will be asked to undress, put on a hospital gown, and lie down on the examination table
2. For an external scan, the sonographer will apply a cold gel onto your skin over your lower abdomen. This gel helps to transmit sound waves through the probe. Your sonographer will move the probe over your lower abdomen and check the images on a screen. An external ultrasound may take up to forty-five minutes
3. If you are having a vaginal ultrasound, you will be asked to lie on your back with your feet in supports, your knees bent and your legs apart. If this position is difficult, you may be able to lie on your side with your knees drawn up to your chest
4. The sonographer will insert a small, thin ultrasound probe into your vagina. This may feel slightly uncomfortable and cold due to the lubricating gel, but it should not be painful. Tell your sonographer if you feel pain at any time
5. The sonographer will gently move the probe around to get the images they need. They may press gently on your abdomen from time to time so they can see your organs more clearly
6. A vaginal ultrasound normally takes between fifteen and thirty minutes

Possible risks and complications of ultrasound scans

An ultrasound scan is a safe, minimally invasive procedure that doesn't involve any radiation. As such it doesn't pose any risks or complications.

A CT scan uses multiple X-rays taken from different angles to create a 3-D image of an area of your body. Your consultant may order a CT scan to check what stage cancer you have and whether it has spread to other parts of your body. They may also use a CT scan to help plan any surgery.

Preparing for your CT scan

For some CT scans, you will not be able to eat or drink for a period of time before the scan. Instructions on preparing for your CT scan will be in your appointment letter. Call the hospital if you have any questions about preparing for your CT scan.

If you are pregnant or think you may be pregnant, let the hospital know before your appointment. Pregnant women should not have CT scans except in emergencies.

What happens during a CT scan?

1. When you arrive for your scan, the radiographer will explain the procedure to you. You may be given a questionnaire or checklist to fill out before your scan. Ask your radiographer if you have any questions or concerns about your CT scan and let them know if you are claustrophobic or feel anxious about your scan
2. You will be asked to change into a hospital gown and remove any metal objects such as jewellery, hair clips, or underwired bras. Metal can interfere with the images on the scan. You will have a small plastic tube called a cannula inserted into a vein in your hand 
3. When you are ready, you will be taken into the scanning room. The CT scanner appears as a large cylinder. You will lie on the scanning table in the centre of the cylinder 
4. You may be given an injection of a substance called contrast into your cannula. This is a type of dye that shows up body tissues more clearly on the scan. As the contrast is injected you may feel hot, have a metallic taste in your mouth, or feel like you are passing urine when you aren't. This is normal and passes within a few minutes 
5. When you are in the right position, your radiographer will leave the room. They can see you on a screen or through a window from the control room and talk to you through an intercom during your scan
6. The scanning table gradually moves through the cylinder as your scan takes place. A CT scan isn’t painful, but you need to keep as still as possible during your scan which may be uncomfortable. There may be a whirring noise from the scanner during your CT scan. This is normal and nothing to worry about. The scan normally takes about twenty to thirty minutes
7. When your scan is finished, your radiographer will come back into the scanning room and lower the table so you can get up
8. If you had an injection of contrast, you will need to stay in the department for around fifteen to thirty minutes to make sure there are no adverse effects. Your radiographer will remove the cannula before you go home
9. You can resume normal activities like driving and going back to work straight away after your scan

Possible risks and complications of a CT scan

A CT scan is generally very safe, but as with any medical procedure it carries a small risk of complications, including:

• Allergic reaction to the contrast
• Bruising and swelling around the cannula site
• Kidney problems caused by the contrast
• Exposure to radiation during a CT scan can slightly increase your risk of cancer in the future

Your consultant will only recommend a CT scan if the benefits far outweigh the risks.

Your consultant may order a chest X-ray to see whether the cancer has spread to your lungs or to check your fitness for surgery.

What happens during a chest X-ray?

You don't need to do anything to prepare for your chest X-ray.

1. When you arrive for your appointment, your radiographer may ask you to remove any jewellery and change into a hospital gown. 
2. You will normally stand with your chest against the X-ray machine. If standing is difficult, your radiographer will take the X-ray with you in a different position. 
3. When you are ready, your radiographer will then go behind a screen to take your X-ray. They may ask you to hold your breath for a few seconds while your X-ray is being taken.

An X-ray is a quick and painless procedure. When your X-ray is finished, you can go home straight away.

Possible risks and complications

X-rays are a routine procedure and are generally very safe. They do emit a very small amount of radiation, but this is unlikely to cause you any problems in the future. The benefits of having an X-ray far outweigh the risks.

Your consultant may take small samples of tissue called biopsies from your ovaries if ovarian cancer is suspected. The tissue samples are then examined in a laboratory to determine if they are cancer. In some cases, if your cancer is advanced, or difficult to reach, you may need to have a laparoscopy instead.

What happens during image-guided therapy?

This procedure takes place in the CT scanning or ultrasound room.

1. First, your consultant injects local anaesthetic into the area to make it numb
2. Next, they use the CT or ultrasound scanner to guide a needle into the correct place to take the biopsy
3. Your consultant will take a biopsy or biopsies from your ovary or omentum (the layer of fatty tissue that covers your abdominal organs)
4. After your image-guided biopsy, you will need to rest for a while. You can normally eat and drink and get up and walk around within a few hours. In some cases, you may need to stay overnight

Possible risks and complications of an image-guided biopsy

Image-guided biopsy is a generally safe procedure, but there is a small risk of moving cancer cells along the needle incision site which may cause the cancer cells to spread. This is very rare.

A laparoscopy, otherwise known as keyhole surgery, is a procedure where a small camera is inserted through an incision in your abdomen. It can be used to see whether your cancer has spread, to take biopsies, or even to remove your ovaries in a procedure called a laparoscopic oophorectomy.

Preparing for your laparoscopy

Before your laparoscopy, you will have a physical examination to check that you are fit enough for surgery. This may include:

• Your weight
• Blood pressure
• Pulse
• Temperature
• Blood test
• ECG (heart trace)
• Chest X-ray

Tell your consultant about any medical conditions, allergies, or medicines you are taking before your surgery. If you are taking blood thinners like aspirin or warfarin, your consultant may tell you to stop taking them for a few days before your surgery. This is to reduce the risk of bleeding during the operation.

You will not be able to eat anything for six hours before your operation. You can normally drink water up to two hours before.

Your consultant will give you instructions on how to prepare for your laparoscopy. Follow their instructions carefully and let them know if you have any questions.

What happens during a laparoscopy?

Laparoscopy is normally performed under general anaesthetic which means you'll be asleep for the procedure.

1. After your skin is cleaned with an antiseptic solution, your consultant will make two or three small incisions (cuts) in your abdomen
2. Your abdomen will be filled with carbon dioxide gas through one of the incisions. This makes it easier for your consultant to see your organs clearly
3. Your consultant inserts a thin tube with a light and camera through one of the incisions. They will see images of your organs on a large screen and examine them for signs of cancer
4. Surgical instruments are inserted through other incisions to take tissue samples (biopsies). These will be sent to the laboratory to check for cancer
5. When the procedure is finished, your consultant will close the incision with stitches and apply a sterile dressing
6. A laparoscopy normally takes about half an hour and is usually done as a day case meaning you can go home the same day

Possible risks and complications

Like any surgical procedure, a laparoscopy carries a small risk of complications. These may include:

• Wound infection
• Bleeding
• Blood clots
• Damage to nearby organs like the bowel

This is a type of open surgery where your consultant makes an incision in your abdomen and examines your abdominal area for signs of cancer. They may take biopsies, or if they find cancer, they may remove it, but only if you have consented to this beforehand.

Preparing for a laparotomy

Before your laparotomy, you will need to have a physical examination to check that you are fit enough for surgery. This may include:

• Your weight
• Blood pressure
• Pulse
• Temperature
• Blood test
• ECG (heart trace)
• Chest X-ray

Tell your consultant about any medical conditions, allergies, or medicines you are taking before your surgery. If you are taking blood thinners like aspirin or warfarin, your consultant may tell you to stop taking them for a few days before your surgery. This is to reduce the risk of bleeding during the operation.

You will not be able to eat anything for six hours before your operation. You can normally drink water up to two hours before.

Your consultant will give you instructions on how to prepare for your laparotomy. Follow their instructions carefully and let them know if you have any questions.

What happens during a laparotomy?

A laparotomy is normally performed under general anaesthetic. This means you will be asleep during your surgery.

1. Once the area is cleaned with an antiseptic solution, your consultant makes an incision down the middle of your abdomen
2. They will examine the area and take samples of tissue and fluid to send to the laboratory to check for cancer cells
3. When the operation is complete, your consultant will close the incision with stitches and apply a sterile dressing
4. After your laparotomy, you may need to stay in hospital for a couple of days. Full recovery normally takes around six weeks.

Possible risks and complications

Like any surgery, a laparotomy carries a small risk of complications including:

• Wound infection
• Bleeding
• Blood clots
• Damage to nearby organs like the bowel, bladder, or blood vessels

Your consultant will explain all the possible risks and complications to you before your procedure. Please ask any questions and discuss any concerns you may have before your surgery. This will help put your mind at rest and allow you to make an informed decision.

One of the symptoms of ovarian cancer is a build-up of fluid in your abdomen. This is called ascites. Ascites can be a sign that your cancer has spread, or it may be a symptom of another condition. Your consultant may take a sample of fluid from your abdomen to check the cause of your ascites.

What happens during fluid aspiration?

Fluid aspiration is normally done as a day case meaning you'll go home the same day.

1. Your consultant will inject a local anaesthetic into your abdomen to numb the area
2. They will use a needle to draw out some fluid from your abdomen. The fluid is sent to the laboratory to check for cancer cells
3. If you have a lot of fluid on your abdomen your consultant may remove more fluid to relieve pressure on your abdomen. This is a procedure known as an abdominal tap or abdomen paracentesis

Possible risks and complications

Fluid aspiration is a normally safe procedure, but as with all medical procedures there is a small risk of complications including:

• Low blood pressure
• Pain
• Infection and inflammation of the abdominal lining (peritonitis)
• Blockage of the tube that drains fluid
• Leakage of fluid from the tube site after the tube is removed

The RMI is a tool used by doctors to assess your risk of malignancy (cancer).

The RMI combines the results of your CA 125 blood test, ultrasound, and whether or not you are past the menopause to give you a score. If you have a high RMI score you may be referred for further tests or surgery.

Sometimes a CT scan may be performed so that your consultant can examine your ovaries, but in most cases, you need surgery to diagnose ovarian cancer.

If your RMI index is low, but you have symptoms of ovarian cancer, your consultant may ask you to come back for repeat tests in three months.

You will receive the results of your test within a few days or weeks, depending on the type of test you had. Ask your consultant when you can expect to get the results of your tests.

Getting the results of your tests can be an anxious time and it may help to bring someone with you to your appointment. It may also help to write down any questions you have about your results beforehand.

When you get your results, your consultant will explain what they mean and answer any questions you may have. It's important that you understand the results of your tests and that you are well-informed about what will happen next. Please ask your consultant any questions you may have and discuss any concerns about your test results and what they mean for you going forward.

If your test results show you have ovarian cancer

Being diagnosed with ovarian cancer is an understandably difficult and frightening time. Being well-informed and clear about your diagnosis and what happens next can help reduce anxiety and make you feel more in control.

If you are diagnosed with ovarian cancer, you will be referred to a team of specialists that includes nurses, doctors, and surgeons specialising in different aspects of cancer care. The team will be on hand to support you throughout your diagnosis, and through any further tests and treatment.

We answer some of your most commonly asked questions about tests for ovarian cancer.

Can a blood test detect ovarian cancer?

The CA 125 blood test may be a marker for ovarian cancer, but it is not reliable enough to diagnose ovarian cancer on its own. If you have abnormally high levels of CA 125, your consultant may request further tests like an ultrasound or CT scan.

Can a smear test detect ovarian cancer?

No. A smear test is used to detect abnormal cells on the cervix, or cervical cancer. It cannot detect ovarian cancer.

How long do ovarian cancer blood tests take?

You will normally receive the results of your CA 125 blood test within a couple of weeks. Check with the hospital when you can expect the results when you have your test.

Can a urine test detect ovarian cancer?

There's currently no urine test available to detect ovarian cancer. Recent research has suggested that certain biomarkers for ovarian cancer may be detectable in urine samples, but the research is still in its early stages.

What is the blood test for ovarian cancer called?

The blood test that may be an indicator of ovarian cancer is called the CA 125.

How accurate is the blood test for ovarian cancer?

The blood test for ovarian cancer (CA 125) on its own is not an accurate means of diagnosing ovarian cancer. High levels of CA 125 indicate inflammation of the pelvic region but are not specific as to the cause. A high CA 125 can be due to other conditions like endometriosis or fibroids. It is also possible to have a negative CA 125 result and have ovarian cancer. If you have symptoms of ovarian cancer, a high CA 125 and an abnormal ultrasound result, your consultant may refer you for further tests.

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant best suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about tests for ovarian cancer book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. Urine Biomarkers for the Early Detection of Ovarian Cancer – Are We There Yet? PubMed
2. ROCA FAQs, Roca Test
3. Tests and next steps: Ovarian cancer NHS
4. Tests for ovarian Cancer Cancer Research UK
5. Ovarian Cancer: What should I know about screening? Centers for Disease Control and Prevention
6. Ovarian Cancer Macmillan Cancer Support