Detecting Ovarian Cancer
Each year in the United States, there are approximately 22,000 women newly diagnosed with ovarian cancer. This is a deadly cancer that ends in death in approximately 16,000 women each year. Prevention and detection for this cancer — and many other cancers — become increasingly important as women age.
Ovarian cancer is often found late with symptoms of bloating and sometimes abdominal pain. Mortality is high, and detection often comes at a time of advanced disease.
The disease has two different cell types: one is the epithelial (surface of the organ) cells of the ovary, and the other is the germ cell variety that comes from egg cells in the ovaries. Regardless of the cell type of the cancer, early detection is an important strategy in lowering mortality because approximately 90 percent of women diagnosed early live more than five years. Only approximately 25 percent of women diagnosed with advanced disease live that long.
Why is it difficult to diagnose this disease? First, it is not like breast cancer in which breast self-examination can detect a “lump.” Additionally, ovarian cancer detection doesn’t include any type of screening imaging such as mammography. The symptoms of ovarian disease are non-specific: they include such vague symptoms as abdominal bloating, nausea, indigestion, gas, urinary frequency, abnormal vaginal bleeding and weight loss or gain. Even to men, these symptoms are readily perceived as common and not particularly ominous signs of a potentially life threatening disease.
The next questions are: can ovarian cancer be detected early, and is there a blood test that can identify women who have the disease? Women of all ages should have regular (annual) pelvic examinations, during which the clinician can try to feel any masses. A routine pap smear does not detect ovarian disease.
There has been a widely circulated e-mail that originated from a now deceased patient named “Carolyn” who advised every woman to have a screening test call the CA-125 to detect ovarian cancer. This e-mail brought the plight of one patient to a large audience and further fueled the debate of the use of blood tests to find cancer. As many readers know, the prostate specific antigen (PSA) is used to detect prostate cancer and is thought to be responsible for the earlier detection of this cancer in men. The question is whether the CA-125 is a reliable test to use in women to discover ovarian cancer.
CA-125 is a blood substance that accompanies ovarian cancer, as well as a number of other cancers. It also is found in non-cancer patients with a variety of normal and abnormal situations. Therefore, the test may detect CA-125 in many people who do not have any kind of cancer. The test is not regarded by the National Cancer Institute or most cancer organizations as a recommended screen for cancer. The CA-125 test could result in too many false positives, resulting in needless anxiety. A false positive test result also could result in expensive imaging studies and unnecessary surgery. In other words, added expense, risks and worries are often the result of routine use of CA-125 for ovarian cancer screening.
What is the role of CA-125? This blood test should be used in women who are at high risk of developing ovarian cancer (see Table 1) or to track treatment progress in women who have the disease since CA-125 is a marker that correlates with treatment. In women at risk for ovarian cancer, the blood test should be used with vaginal ultrasound, which a painless diagnostic test.
The bottom line is that ovarian cancer is relatively rare but a real threat to healthy aging. Researchers have not yet identified a highly reliable blood test to detect it. Therefore, if the symptoms mentioned above continue for more than two weeks, a physician should be consulted and diagnostic techniques should be used to rule out this potentially lethal disease.
- Family history of ovarian, breast or colon cancer
- History of personal breast, endometrial or colon cancer
- Breast/Ovarian cancer syndrome(s) BRCA or HHNPCC
- Uninterrupted ovulation without pregnancies, use of birth control pills, early menses, or late menopause
- Use of talc-based powders in the genital area or use of condoms dusted with talc
- Increasing age