Diagnosis & Staging
Ovaries are located in your pelvis, one on each side of your uterus.
They are almond-shaped and about 4 cm (1.5 inches) long.
Ovaries are the main source of the hormones estrogen and progesterone.
Image of ovaries
Ovarian cancer is harder to find in the early stages because it has symptoms that are very subtle.
These symptoms may also be signs of other conditions and may include:
- Pain or discomfort in your abdomen (belly).
- Swelling or bloating in your lower abdomen.
- Indigestion, gas, nausea, constipation, diarrhea.
- Unusual bleeding (heavy periods or bleeding after menopause).
- Frequent and urgent need to urinate (go pee).
- Loss of appetite.
- Feeling full even after a small meal.
- Pain in your lower back or legs.
- Pain during intercourse (sex).
If you have any signs or symptoms that you are worried about, please talk to your family doctor or nurse practitioner.
Tests that may help diagnose ovarian cancer include:
- Physical examination: includes an internal pelvic examination to feel the ovaries. If you have regular Pap tests to screen for cervix cancer, this type of exam is usually done at the same time.
- Blood tests for CA 125 and CEA. These proteins may be higher in the blood of people who have ovary cancer. These proteins are also called tumour markers.
- Ultrasound: to see the tumour.
- Chest X-ray: to see if the cancer has spread to your lungs.
- CT (Computed tomography) scan: to see if the cancer has spread to other organs, tissues or lymph nodes.
- MRI (magnetic resonance imaging): to see if the cancer has spread to other organs, tissues or lymph nodes.
- PET (positron emission tomography): to see if the cancer has spread to other organs, tissues or lymph nodes.
- Exploratory surgery to get a biopsy (sample of tissue). A specialist doctor (pathologist) will examine the tissue to see if there is cancer. Only a biopsy can diagnose ovary cancer.
- Make up 90% (90 out of 100) of ovarian cancers.
- There are different types: serous, mucinous, endometrioid, clear cell and undifferentiated.
- Serous carcinoma is the most common type.
- Mostly affects people over the age of 50.
- Epithelial ovarian cancer is the cancer that patients and doctors call "ovarian cancer".
- These tumours make up about 10% (10 out of 100) of ovarian cancers.
- Types of non-epithelial tumours:
- Germ cell tumours
- Start in the egg-producing cells of the ovary.
- Most tumours are benign (not cancer) but some are malignant (cancer).
- Mostly affects people under the age of 20.
- Respond well to treatment.
- Stromal tumours
- Very rare.
- Start in the connective tissue in the ovary.
- Mostly affects people over the age of 50.
Staging describes the cancer. Staging is based on how much cancer is in the body, where it was first diagnosed, if the cancer has spread and where it has spread to.
The stage of the cancer can help your health care team plan your treatment. It can also tell them how your cancer might respond to treatment and the chance that your cancer may come back (recur).
Ovarian cancer is staged during and after surgery. All tissues removed during surgery are examined and tested for cancer. After the tissues are examined, a stage is assigned to the cancer.
- Stage 1: Cancer is only in the ovaries.
- Stage 2: Cancer is in one or both ovaries. Cancer has spread into the pelvis.
- Stage 3: Cancer has spread to areas outside the pelvis or to local lymph nodes.
- Stage 4: Cancer has spread to other parts of the body (distant metastasis).
For more information about staging, see About Cancer.
The grade of the cancer describes how different the cancer cells look from normal cells and how fast the cancer cells are growing. A pathologist will give the cancer a grade after looking at the cells under a microscope.
Ovarian cancer can be grade 1, 2 or 3. The lower the number, the lower the grade.
Low grade: cells are abnormal but look a lot like normal cells. Low grade cancers usually grow slowly and are less likely to spread.
High grade: cells are abnormal and do not look like normal cells. High grade cancers usually grow more quickly and are more likely to spread.
