What tests might I have after being diagnosed?

If your first tests and exams strongly suggest that you have ovarian cancer, you’ll likely have other tests. These tests help your healthcare providers learn more about your cancer. They can help show if the cancer has grown into nearby areas or spread to other parts of your body. The test results help your healthcare providers decide the best ways to treat the cancer. If you have any questions about these or other tests, talk with your healthcare team.

The tests you may have can include:

• Chest X-ray

• Positron emission tomography (PET) scan

• Colonoscopy

• Laparoscopy

• Genetic testing

Imaging tests

Chest X-ray

This test is done to see if the cancer has spread to your lungs.

PET scan

This test is used to look for cancer throughout your body. Your healthcare provider puts a small amount of a radioactive sugar into your blood. He or she does this by putting a needle into one of the veins on your arm or hand. Over about an hour or so, it’s taken up by active cells in your body that need a lot of energy. This includes cancer cells. A special camera then scans your body to look for collections of the sugar. These show up as “hot spots” on the scan. They may be a sign of cancer.

Colonoscopy

For this test, you’re put into a deep sleep. Your healthcare provider puts a long, lighted tube into your rectum and 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.

Laparoscopy

You’re put into a deep sleep for this test. Your healthcare provider then makes a small cut (incision) in your belly (abdomen). He or she then puts a long thin tube 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. Your provider can use small tools through the tube to take out tissues samples if he or she sees 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 diagnosing ovarian cancer. All women who have 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. Testing might include:

• BRCA 1 and BRCA 2 testing.

  Changes in the BRCA 1 and BRAC 2 genes can mean that certain treatments are more likely to work for epithelial ovarian cancer. These genetic changes might be "germline" mutations. This means they're inherited and present in all our 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 relative) may want to discuss their options for getting tested with a qualified genetic counselor. (All genetic evaluations should be done by trained clinicians that know about hereditary cancer syndrome.)

  If you don't have germline BRCA1 and BRCA2 mutations, you can still have mutations that develop after conception in these genes (somatic mutations). These changes are not passed on in families, but happen after birth and found only in the cancer cells.

  Tumor testing is done to check for these changes (mutations). The tests are done on a small piece of the tumor. 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.

  Women with clear cell, endometroid, 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. Make sure to get ready for the tests as instructed. Ask questions and talk about any concerns you have.