TESTING FOR OVARIAN CANCER
If you are experiencing potential ovarian cancer symptoms, your doctor may suggest a pelvic exam, a CA-125 blood test and a transvaginal ultrasound to check if everything is okay.
Pelvic examination
A pelvic examination is an internal examination that checks for lumps and other changes in your tummy and pelvis.
Before they start, your doctor will explain the procedure and get your consent; it’s your choice whether you want to have this procedure. You can ask for a support person to be present during the exam, either someone you bring with you, or a nurse or staff member at the practice.
During the pelvic exam, the doctor will insert two lubricated and gloved fingers inside your vagina and use the other hand to press gently down on your abdomen. It might feel a little uncomfortable, but it should not be painful.
If they find something, this does not necessarily mean you have ovarian cancer, but you should be prioritised for an ultrasound, usually within two weeks.
Many people with ovarian cancer have a normal pelvic exam; if your pelvic exam is normal you may need more tests.
CA-125 blood test
A CA-125 blood test looks for a specific protein in the blood that can sometimes be elevated because of ovarian cancer.
Ovarian cancer is more likely if the result is 35 units/mL or higher. However, most people with an elevated CA-125 result do not have ovarian cancer, and some people with ovarian cancer have a normal blood test; this is more common in younger people with ovarian cancer and early-stage ovarian cancer.
A normal blood test does not rule out ovarian cancer. If you continue to have symptoms, it is important to tell your doctor.
Ultrasound
An ultrasound looks for growths and other changes in your ovaries, gynaecological organs and tummy. An ultrasound is a safe and painless test which uses sound waves to create images of structures inside your body. If an ultrasound finds changes, they could be cancer or benign (non-cancerous).
The person who does the test is called a sonographer. Before the procedure starts, the sonographer will explain what they will do and check you are okay to continue. Two types of ultrasound scans will be done.
Pelvic ultrasound
A pelvic ultrasound helps see inside the abdomen and pelvis. During this exam, the sonographer will put lubricating gel and a sensor on your tummy and move the sensor to view different areas.
Transvaginal ultrasound
A transvaginal ultrasound helps the sonographer see the ovaries better. During this test, a sensor gets inserted into the vagina. The sensor used is larger than a tampon but smaller than the typical speculum used during cervical screening and it will be covered in a plastic/latex shield and lubricating gel. You can ask to insert it yourself. During the exam, the sensor will be turned gently and angled to look at different areas. You might feel mild pressure.
Additional considerations
For most people, having an ultrasound is not a big deal, but if you have difficulties with internal exams or have any concerns, you should talk to your GP. They can prescribe a medication to help you feel more relaxed and request a longer appointment time. Tell the sonographer how you are feeling as well. They are trained professionals and should go out of their way to make you feel comfortable.
Remember, you can stop or pause the exam at any time if you don’t feel comfortable. You can also bring a support person or ask for someone else in the clinic to be present during the test.
Should I be seen in public or pay to go private?
The Australian Optimal Care Guidelines for ovarian cancer recommend that people with symptoms suspicious of ovarian cancer have an ultrasound within two weeks of their GP appointment.
Your doctor can refer you publicly or privately. In New Zealand, how quickly you are seen in the public system depends on your CA-125 blood test and pelvic exam. Where you live can also make a difference.
If you can afford to go private (or have health insurance to help with costs), you will usually be seen a lot quicker; a private ultrasound costs about $400.
Results
If all the results are normal your GP will investigate other causes. In addition, they might suggest repeating the CA-125 blood test four to 12 weeks later because, very occasionally, the CA-125 blood test and ultrasound can miss ovarian cancer the first time.
If any of the results are abnormal, you might be asked to repeat the tests at a later date or get referred to a specialist (a gynaecologist or gynae-oncologist) for further investigation. If you get referred to a specialist, you may have more blood tests and another form of imaging like a CT scan.
If your symptoms get worse it’s important to tell your GP (even if you are waiting for a specialist appointment).
Is there a screening test for ovarian cancer?
Ovarian cancer screening is generally not recommended. Ovarian cancer screening increases the chance that someone will have surgery they don’t need without significantly reducing their chance of dying from ovarian cancer.
A screening test is when people with no signs or symptoms of disease get tested. People with persistent symptoms should get tested for ovarian cancer; this is not the same as screening.
Note: this content has been reviewed by a gynaecological cancer specialist in New Zealand. Information is provided for general use and should not be a substitute for professional medical advice.
Last reviewed: 16 January 2024