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:

• Chest X-ray

• Computed tomography (CT) scan

• Positron emission tomography (PET) scan

• Colonoscopy

• Laparoscopy

• Genetic testing

Imaging tests

Chest X-ray

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.

CT Scan

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.

PET scan

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.

Colonoscopy

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.

Laparoscopy

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.

Genetic testing

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 decisions.

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.