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Ovarian Cancer - Still Waiting for Early Detection
The Quiet Killer
We're Not There Yet
I am often asked about where things stand with any sort of screening program for ovarian cancer, and the sad news is that not much has changed over the years. We still do not have a reliable test that could be widely applied and be reasonably capable of predicting women who have a higher risk of this deadly form of female genital cancer. Sure, there is always ultrasound and MRI as well as a blood test or two to check for cancer antigens that are sometimes associated with ovarian tumors, but none of these is satisfactory and none have received universal approval among cancer specialists as screening tests.
Expanded tests for cancer biomarkers in the blood have been proposed, and one such test (OVA1 Ovarian Triage Test) did receive FDA approval for use in 2009. But it remains controversial, and there is no consensus among gynecologic cancer specialists as to the best use of this test. For now, this test is mainly used to identify the relative risk of cancer in women who have already been identified as having a pelvic tumor based on examination or radiologic imaging - the surgeon can then have a better idea of how to best plan the surgery. So how does the average woman figure out if something is going on in those 2 x 3 centimeter ovaries?
Paying attention to what has been described as the "whisper" of ovarian cancer symptoms is key - this includes pelvic pain, abdominal pain or bloating, actual swelling of the abdomen and/or feeling full soon after beginning to eat. If even one of these symptoms is present for more than two weeks per month for up to one year, there is a 50-90% sensitivity for actual ovarian disease - this varies with the age group, and older women with these symptoms have a higher risk. But don't all women have similar symptoms at times? Of course, but it is unusual to have those for more than 2 weeks at a stretch.
Physical examination to check for enlarged ovaries or the presence of a mass in the pelvis is important, but if the woman is overweight, the exam is much less accurate. Imaging alone, such as ultrasound exam of the ovaries can actually lead a woman to go through a surgery for something that was never going to cause any problems at all (i.e. benign ovarian cysts). Some specialists in this area of medicine have suggested that combining the vaginal ultrasound with blood testing for CA-125 cancer antigen is helpful, but this test combination is still reserved for women who have already been identified as being at higher risk for ovarian cancer.
Women at higher risk would certainly include those who have first degree relative (mother or sister) with definitively diagnosed ovarian cancer. Even though hereditary ovarian cancer accounts for only about 10% of all cases, those women may want to have genetic testing for BRCA gene mutation. Relatives who had simple or other benign ovarian cysts or endometriosis do not factor into this group. Women with relatives with certain other GYN cancer history such as cervical disease also do not factor into that higher risk group. Ovarian cancer risk is actually DECREASED in women who have had multiple pregnancies, breastfed their children, have had their tubes blocked for sterilization (or have had hysterectomy) and those who have taken birth control pills for at least five years.
Even though ovarian cancer is only the fifth most common malignancy in women, it kills more than any other reproductive organ disease. Most cases (70%) are detected in the later stages (III or IV) where the tumor has already spread to distant organs and tissues. But the survival is dramatically improved if the disease is in stage I and confined to one ovary (90%). So the search for a good screening tool is still on. At this time, the American College of Obstetricians and Gynecologists does not recommend whole-population screening for this cancer, but they do advocate women and their health care providers to pay close attention to any concerning, persistent symptoms.
Shannon Miller - Olympic Champion
Recently, Olympic gymnast Shannon Miller revealed details of her battle with ovarian cancer. Her disease was early stage and detected on physical exam. After surgery, she underwent chemotherapy and appears to be doing just fine.
Women's Health Blog
National Institute of Health Link
- Ovarian Cancer: MedlinePlus