Ovarian Cancer: Tests After Diagnosis
What tests might I have after being diagnosed?
After an ovarian cancer diagnosis, you’ll likely need more tests. These tests help
your healthcare providers learn more about the cancer. They can help show if it has
grown into nearby tissues or spread to other parts of your body. The test results
help your healthcare providers work with you to decide the best ways to treat the
cancer. If you have any questions about these or other tests, be sure to talk with
your healthcare team.
Some of the tests used after diagnosis include:
This X-ray may be done to see if the cancer has spread to your lungs. For the test,
you stand in front of a rectangular target area where the X-ray film is held. You
may be asked to hold your arms to the side or over your head. You take a breath and
stay still for a few seconds. An X-ray will be done from the front and from the side.
A CT scan takes many X-rays from different angles. A computer combines the X-rays
to create detailed images of your body. This may help your provider know how large
the tumor is and if the cancer has spread to other parts of your body.
This test is used to look for cancer throughout your entire body. A sugar solution
that contains a mildly radioactive material is put into your blood through a vein
in your hand or arm. Cancer cells use the sugar faster than other cells, so the radioactive
material collects in them. Then a machine takes pictures of your whole body. The places
where the solution collects show up as "hot spots" on the scan. A PET scan is often
combined with a CT scan (PET-CT scan). This allows areas that show up on the PET scan
to be compared to the more detailed images of the CT scan. This test helps look for
cancer that has spread from where it first started.
For this test, medicines are used to put you into a deep sleep. A long, lighted tube
with a camera on the end is then put into your rectum and moved through your colon.
Colonoscopy is used to see if cancer has spread to the colon or rectum, or if the
cancer might have started in the colon itself. If there are changes that look like
cancer, small pieces of tissue can be taken out through the tube for testing.
You’re put into a deep sleep for this test. A small cut (incision) is made in the
skin over your belly (abdomen). A long, thin, lighted tube is put into the cut. This
tube sends pictures to a computer screen. This lets your healthcare provider look
closely at your ovaries and the inside of your abdomen. If needed, small tools can
be put in through the tube or through other small cuts to take out tissues samples
of spots that may be cancer. This test helps your provider see if and how far the
cancer has spread.
Many experts agree that genetic testing and counseling should be part of the management
of ovarian cancer. Everyone with ovarian cancer should be tested at the time of diagnosis
or as soon as possible for certain types of gene changes (mutations). Genetic testing
can be done with blood, saliva, or pieces of the tumor. Testing can help guide treatment
Genetic testing might include:
BRCA1 and BRCA2 testing
Changes in the BRCA1 and BRCA2 genes can mean that certain treatments are more likely to work for epithelial ovarian
cancer. BRCA gene changes might be "germline" mutations. This means they're found
in all your cells at birth. They can be found in cells from your blood or saliva.
This type of gene change can be passed in families (inherited). If you have germline
gene mutation, your family (blood relatives) may want to discuss their options for
genetic testing with a qualified genetic counselor. (All genetic evaluations should
be done by trained clinicians who know about hereditary cancer syndromes.)
If you don't have germline BRCA1 and BRCA2 mutations, you can still have mutations that develop in these genes later in life
(called somatic mutations). These changes are not passed on in families, but happen
after birth and are found only in the cancer cells.
The tests are done on small pieces of tumor to check for these changes (mutations).
Sometimes, tumor testing isn't done unless the cancer comes back (recurs) after treatment.
This information can help guide further treatment decisions.
DNA mismatch repair testing
A person with clear cell, endometrioid, or mucinous ovarian cancer should be offered
tumor testing for mismatch repair deficiency (dMMR). To do this, tumor cells are tested
to see if there's a problem in repairing damaged DNA. Normally, when cells grow and
divide, DNA is copied to go into the new cells. A system called the DNA mismatch repair
system looks for and fixes mistakes made when the DNA divides and makes copies of
itself. When this system isn't working, mistakes happen. Over time, these mistakes
(or mutations) can build up and may cause cancer. Results of this test can help guide
treatment if ovarian cancer comes back.
Working with your healthcare provider
Your healthcare provider will talk with you about which tests you'll have. Get ready
for the tests as instructed. Be sure you know what the test will be like and why it's
being done. Talk with your provider about any concerns or questions you have.