What should I know about Ovarian Cancer screening?

We thought we’d mark Ovarian Cancer Awareness Month (September) by discussing the issue of screenings. As with other forms of cancer, early detection is a significant advantage when battling this disease. Unfortunately, for most women, there is no effective way to screen for cancer in the ovaries, peritoneum (a layer of tissue that lines the abdomen), or fallopian tubes. According to the CDC, there is no straightforward and reliable way to screen for ovarian cancer when there are no symptoms or signs. Current tests are not reliable or accurate enough, especially for early-stage disease. Furthermore, the risks of their use generally outweigh potential benefits. This is one reason why it’s important for all women to be aware of the risk factors for this illness and to stay sensitive to changes that might be symptoms of it.

Signs to look for

Some people are under the misguided perception that pap smear tests are for ovarian cancer, as well as cervical cancer, but this is not the case. Women should be alert for telltale warning signs, which can help reduce the risk. Ovarian cancer rarely has noticeable symptoms when it is in its earliest stages. As the cancer progresses, subtle symptoms begin to appear, but they still may not be noticed right away, or they may be blamed on other common conditions, such as constipation or an irritable bowel. The symptoms of ovarian cancer include:

• Abdominal bloating or swelling
• Pain in the abdomen or pelvis
• Difficulty eating, or feeling full quickly
• Lack of appetite
• Feeling an urgent need to urinate
• Needing to urinate frequently
• Change in bowel habits (constipation or diarrhea)
• Change in menstrual periods
• Vaginal bleeding between periods
• Back pain
• Weight gain or loss

Although the symptoms of ovarian cancer may be vague, particularly in the early stages, they are usually fairly constant and represent a change from how you normally feel. Symptoms also worsen as the cancer progresses. Schedule an appointment with a doctor if the signs seem to indicate ovarian cancer. Be sure to inform them if there is a history of ovarian cancer in the family.

At risk women

Increased risk for ovarian cancer exists if you have:

• A family history of ovarian or breast cancer
• A personal history of breast cancer prior to age 40
• A personal history of breast cancer diagnosed prior to age 50, as well as one or more close relatives diagnosed with breast or ovarian cancer at any age
• Two or more close relatives diagnosed with breast cancer prior to age 50, or with ovarian cancer diagnosed at any age
• Ashkenazi Jewish heritage and a personal history of breast cancer prior to age 50
• Ashkenazi Jewish heritage and a first- or second-degree relative diagnosed with breast cancer prior to age 50, or with ovarian cancer at any age

Other factors that generally increase risk for ovarian cancer include early menstruation, late menopause and endometriosis.

High risk for ovarian cancer exists if you inherited certain mutations in genes that are involved in cell growth, division, and DNA repair. Women at increased risk have a one in five chance or higher of ovarian cancer. High risk conditions include:

• the BRCA1 or BRCA2 genes (relative risk for ovarian cancer is greater than six times that of the general population)
• a mismatch repair gene mutation associated with a hereditary cancer syndrome known as Hereditary Non-Polyposis Colon Cancer (HNPCC)/Lynch syndrome

Diagnosis

There are four types of tests and procedures:

1. Pelvic exam: The doctor inserts gloved fingers into the vagina while resting their other hand on the stomach to palpitate the pelvic organs, including the ovaries and adnexa where ovarian cancer arises from.
2. Imaging test: Transvaginal ultrasound is commonly used to assess the ovaries along with CT imaging. These tests enable doctors to examine the structure, size and shape of the ovaries. However, CT imaging should not be used as a screening test for asymptomatic or average risk women.
3. Blood test: This checks for organ function for overall health. CA-125 protein can be helpful in making the diagnosis because it is a tumor marker that in some cases indicates the presence of ovarian cancer. Because other types of tissue can cause elevated CA-125, the test is not recommended for screening, but rather to be used once suspicion is raised.
4. Surgery: It may be necessary to remove an ovary and test it for cancer with a minimally-invasive biopsy to obtain tissue for testing.

The results of the tests will dictate a strategy for moving forward or not moving forward. The stages of cancer range from Roman numerals I-IV – with Stage I being early disease with the best chance of cure and Stage IV meaning that cancer has spread to other parts of the body.

Weighing the options

Doctors will go through a series of protocols as they perform examinations and conduct treatment. The patient should try to work with her doctor, but the most important thing is to be aware of risk factors and of symptoms that are known to occur with ovarian cancer. If a doctor fails to address concerns about possible risks or symptoms you have, it may be prudent necessary to get a second opinion or change doctors. Overlooked risk factors and symptoms of ovarian cancer can be negligence that leads to a delayed diagnosis, which can cause advanced disease and death.