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What if my GP thinks I have ovarian cancer?

If your GP suspects you may have ovarian cancer they might ask for a blood test to measure your CA125. This is a protein that can be raised in ovarian cancer, but it can also be raised for reasons that are unrelated to cancer.  The GP may also ask for an ultrasound examination of your abdomen and pelvis. This might mean putting the ultrasound probe into your vagina to get a good view of the ovaries.

If the results of these tests suggest that you may have ovarian cancer, your GP should refer you within two weeks to a specialist gynaecological oncologist.  This is a doctor who is a gynaecologist with extra training and skills in treating women who have or may have cancer.  You should receive a confirmed diagnosis within 31 days of cancer being suspected.

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Your first hospital appointment

Your specialist should explain what happens next and how a diagnosis will be made. You may have an MRI or CT scan and an ultrasound or CA125 blood test if these have not been done already.

You will be given an appointment to return and discuss the results of your tests.  Before this second appointment your results will be reviewed by the multidisciplinary team (MDT) that will oversee your care. They will discuss the best treatment plan for you.

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The second appointment

At the second appointment, if your tests suggest you could have ovarian cancer, you may be advised by the MDT to have surgery to confirm the diagnosis. If your scans have shown that cancer is present, or has spread, the MDT may advise you to have chemotherapy first to reduce the tumour, followed by surgery and further chemotherapy.  

Your specialist should tell you about the risks and benefits of these procedures, including side effects.  You should be given time to think about the options. You should also be told about support services available to you.

It can be helpful to take someone with you to hospital appointments as they may remember information that you have missed.  You can take notes if you wish.

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Having surgery first

After this appointment, if it is decided that you should have surgery followed by chemotherapy you will receive a date for admission to hospital for your operation.  You will usually be asked to attend a preoperative assessment a few days before surgery.

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Here are some questions you may want to ask:

If I need surgery, what will be removed?

Can all the cancer be taken away?

What are the risks?

Can my fertility be preserved?

Are there any other tests I need beforehand?

How long will I be in hospital?

How soon will I be able to get back to normal – before I can drive or have sex?

Will the surgery cause an early menopause?

When will I get the results of the surgery?

What will happen following surgery?

Is there someone I can speak to before going into hospital if I have any questions?

If your cancer is diagnosed at a very early stage you may not need chemotherapy after surgery.

If you do need it, you will be offered chemotherapy when you have recovered from your surgery. This usually involves a cycle (dose) of chemotherapy drugs every three weeks for six cycles, lasting 18 weeks.

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Having chemotherapy before surgery

If you are recommended to have chemotherapy to shrink the cancer before surgery, the surgical team will usually arrange a biopsy first of all to check that the diagnosis of ovarian cancer is correct.  This is often carried out by a radiologist who will use scans to locate the best place to take a sample. The biopsy is taken using local anaesthetic to numb the skin.

After the biopsy your surgeon will refer you to an oncologist who will organise your chemotherapy.  You will probably be advised to have three cycles of chemotherapy, one every three weeks for nine weeks.  Each cycle is given over a day in hospital as an outpatient.

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You may want to ask:

What choices do I have for my treatment?

How will I know if the treatment is working?

Will I experience side effects and how long are they likely to last?

What is available to help with side effects?

Are there any other ways of helping myself during treatment?

Will I be able to carry on working?

Who can I contact if I have any questions or problems?

When you have completed the three cycles of chemotherapy you will be reviewed.  You may have another scan to check that the tumour has shrunk enough and arrangements will then be made for surgery.

After your operation you will usually have three more cycles of chemotherapy.  If there is any of the tumour left at the end of surgery your doctor may suggest using bevacizumab (Avastin), a targeted treatment that interferes with the cancer’s blood supply.  This can postpone a recurrence of the illness.

At the end of your chemotherapy you may have another scan to check if any of the cancer can still be seen.

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At the end of your treatment

When you have had a lot of hospital treatment it can be hard to adjust to not being treated or monitored every few weeks. You may feel uncertain about your health and have a lot of questions.  You can speak to your clinical nurse specialist (CNS) or call the Ovacome support line.

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You may want to ask:

How will I be followed up, and for how long?

What further investigations may be done?

What should I be looking out for?

Who can I contact between appointments?

How long will it take to recover?

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Helping yourself

When you are told you have cancer, you are likely to feel very frightened, uncertain, alone and angry. This is a normal and understandable reaction. These feelings may sometimes overwhelm you and stop you from carrying out your usual activities, such as sleeping, eating or working.

Some people develop depression after their diagnosis or during and after treatments.  This can cause poor sleep leading to tiredness, loss of appetite, tearfulness and pessimistic thoughts.  Sometimes depression can cause feelings of anger.  If this is happening to you, it is very important to know that help is available.  It is not a sign of weakness; you are in a very difficult situation and need help and support.

Seeking treatment is important.  Your mental health is as important as your physical well-being.

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Talk to someone! 

Talking to someone about your feelings may be helpful. You may be reassured or directed to someone else who could help. Talking through your worries can stop you feeling so helpless.

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Counselling

When life becomes very uncertain and stressful, it can help to talk to a counsellor.  They are trained to listen and to help you understand your thoughts and feelings. Your GP or clinical nurse specialist (CNS) may be able to put you in touch.

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Dealing with other people

Other people’s reaction to your illness can vary. Some people may seem to avoid you. Others may be over cheerful and not realise how difficult things are for you. This may even be the reaction of those closest to you, usually because they don’t know what to say and are afraid of upsetting you. They may be feeling frightened and confused themselves.

You could respond by saying: ‘I feel angry about what has happened. Can we talk?’ or ‘Things are difficult but I don’t want to talk about it at the moment’. This shows others what you would find helpful from them. It is normal to want to talk about your problems one moment, but not a few hours later.

Sometimes people may tell you that you must stay positive. This may be helpful or not, but you should not feel guilty if you are not able to feel positive all the time. It would be very unusual if you did not have some low points.

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Support groups

No matter how close your friends and family are, it may be helpful to talk to people going through a similar experience. It can be reassuring to speak to someone who has ‘been there’. It can be a chance to talk through some of the worries you might not want to mention to your family in case you upset them.

Ovacome offers support and services including a free support line on 0800 008 7054. 

There is information and advice on our website www.ovacome.org.uk which has a list of local support groups. It also has My Ovacome, a lively on-line forum you can join on the HealthUnlocked  website. You may want to see our newsletter too.

Your clinical nurse specialist (CNS) should know if you have a support group in your area.

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Self-help

Self-help can involve relaxation, complementary treatments, such as reflexology and massage, or changing your diet.  Do check with your medical team before starting a new therapy or diet.

You can get more information about complementary therapies by contacting Penny Brohn UK on 0303 300 0118 or by visiting their website at www.pennybrohn.org.uk

If you would like more information on the sources and references for this fact sheet, please call us on 0800 008 7054. 

If you would like to discuss anything about ovarian cancer, please phone our supportline on 0800 008 7054 Monday to Friday between 10am and 5pm.

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Reviewed by Gordon Jayson PhD FRCP Professor of Medical Oncology, Christie Hospital and University of Manchester

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Disclaimer 

Ovacome fact sheets provide information and support.  We make every effort to ensure the accuracy and reliability of the information at the time of printing.  The information we give is not a substitute for professional medical care.  If you suspect you have cancer you should consult your doctor as quickly as possible.  Ovacome cannot accept liability for any inaccuracy in linked sources.

v.2.2

Date last updated May 2018

Date for review May 2020