ENOvarian cancer diagnosis in Germany usually starts not with a suspicion of cancer but with a mass seen on ultrasound and a raised tumour marker. At home the doctor then says “we need to operate and will see as we go”, and the family wants a second opinion first.
This page covers what the work-up involves, why surgery confirms the diagnosis, what can be done beforehand and which documents to bring. A benign cyst is a different topic, covered under ovarian cyst treatment. The overview of diagnostics in Germany is on a separate page.
Why ovarian cancer is found late
Ovarian cancer is found late because it gives no clear signals for a long time: there is no early warning bleeding and no screening proven to help all women. The complaints stay vague (bloating, pressure, feeling full quickly, a change in bowel habit, a growing abdomen) and are easily blamed on the gut.
Be alert if such complaints persist for several weeks, if ovarian and breast cancer run in the family or if a mutation such as BRCA1 or BRCA2 is known there: this is not a diagnosis, but a reason not to delay the work-up. The German Cancer Research Center’s cancer information service (Krebsinformationsdienst) has a German-language page on ovarian cancer.
What the work-up in Germany consists of
The work-up has three steps. The first is a gynaecological examination with ultrasound, transvaginal and through the abdominal wall: it shows the mass’s size and structure, any fluid in the abdomen and the state of the other ovary, and an experienced examiner can already tell a probable cyst from a suspicious tumour.
The second step is blood tests for tumour markers, above all CA-125, plus others in younger women. A marker alone is not a diagnosis: it can be raised in endometriosis, inflammation and even pregnancy, so it is read only together with the ultrasound. More under tumour marker tests.
The third step is more precise imaging: a CT of the abdomen and chest or an MRI checks for spread on the peritoneum, in the lymph nodes and in the pleura, with a PET-CT if the picture is unclear. A gastroscopy or colonoscopy may also be done, as a stomach or bowel tumour can look the same.
Why the final answer comes from surgery
The final answer comes from surgery, which is the main difference from most other cancers. An ovarian mass is usually not punctured through the abdominal wall, because this can spread cells through the abdominal cavity. Tissue is taken during the operation, and the pathologist names the diagnosis and the tumour type from it.
In practice, German teams usually plan one open operation: the surgeon inspects the whole abdomen, judges whether the tumour can be removed completely and sets the extent accordingly. Laparoscopy, an inspection through small incisions, is kept for particular cases. If the disease has spread too far for immediate removal, a biopsy is taken and drug therapy comes first; a tumour board decides this, not one surgeon.
The third consequence: where the operation is done matters as much as what was found, because the extent of the first operation affects all later treatment. Families therefore look for a gynaecological oncology centre; among AlenMed’s partners, one example is Prof. Martin Pölcher, chief physician of gynaecology at the Rotkreuzklinikum München and head of its gynaecological cancer centre. Treatment is covered under ovarian cancer treatment in Germany.
Genetics and family risk
In ovarian cancer, genetic testing in Germany is offered not on request but as part of the work-up: the German guideline recommends offering it to every patient. The result for inherited mutations, above all BRCA1 and BRCA2, shapes the choice of drug therapy and the advice for sisters and daughters. Blood is taken during the trip and the result may take several weeks, so arrange to receive it remotely.
Testing relatives is a separate conversation that starts with a genetic counsellor, not a test taken “while we are at it”. More under genetic testing.
What you are given and how to plan the trip
You receive a written report: a description of the mass, the marker values, the CT or MRI result, the histology if a laparoscopy has been done, and the tumour board’s recommendation with a plan. Everything else grows out of its wording, so go through it unhurriedly with an interpreter.
The work-up before surgery usually fits into a few working days. If a laparoscopy is decided on the spot, the trip gets longer, so allow for that. The clinic gives the exact timing after seeing the documents.
Frequently asked questions
Can ovarian cancer be diagnosed without surgery?
Only in part: the final diagnosis usually comes from surgery. Ultrasound, markers and CT or MRI show how likely cancer is and where deposits may be, but the tumour type and stage are established from tissue taken during the operation. If surgery is not yet possible, the tissue comes from a biopsy.
How long does the work-up in Germany take?
Usually a few working days before surgery, if appointments and tests are booked back to back. It takes longer if an operation or laparoscopy is decided on the spot. The genetic result comes later and is received remotely. The clinic gives exact timings after seeing the documents, so send them early.
Will tests done at home be accepted in Germany?
Much of it can be: before the trip, the clinic’s doctor decides from the documents what is accepted and what must be repeated. So the images themselves are needed, on discs or as files, not just reports, plus dated test results. After earlier surgery, the slides and blocks are needed to review the histology.
How AlenMed arranges the work-up
AlenMed starts with the documents: ultrasound reports, dated marker values, CT or MRI discs, discharge letters and, after any surgery, the slides and blocks go to a gynaecological oncology clinic. The doctor says what is accepted, what must be repeated and whether a laparoscopy is needed. Then come a written estimate, a visa invitation, consecutive appointments and an interpreter for the consultations and the discussion of the report.
Arrange in advance a companion and spare days, collect the slides and blocks from the laboratory at home (on written request, which takes time) and get the images as files. After the trip, have the final documents translated for your doctor at home.
This material is for information only and is not an offer. The extent of the work-up and further approach are decided by a doctor in person.