Detection

SYMPTOMS

Research suggests that the majority of women with ovarian cancer experience symptoms. Symptoms vary and often depend on the location of the tumor and its impact on the surrounding organs. Many ovarian cancer symptoms mimic those of less life-threatening conditions such as irritable bowel syndrome.

In June 2007, the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists, and the American Cancer Society, with significant support from the Ovarian Cancer National Alliance, formed a consensus statement on ovarian cancer, agreeing that the disease has specific symptoms.

The Ovarian Cancer Symptoms Consensus Statement:[i]
Historically ovarian cancer was called the “silent killer” because symptoms were not thought to develop until the chance of cure was poor. However, recent studies have shown this term is untrue and that the following symptoms are much more likely to occur in women with ovarian cancer than women in the general population. These symptoms include:

  • Bloating
  • Pelvic or abdominal pain
  • Urinary urgency or frequency
  • Difficulty eating or feeling full quickly

Women with ovarian cancer report that symptoms are persistent and represent a change from normal for their bodies. The frequency and/or number of such symptoms are key factors in the diagnosis of ovarian cancer. Several studies show that even early stage ovarian cancer can produce these symptoms.

Women who have these symptoms almost daily for more than a few weeks should see their doctor, preferably a gynecologist. Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Early stage diagnosis is associated with an improved prognosis.

Several other symptoms have been commonly reported by women with ovarian cancer. These symptoms include fatigue, indigestion, back pain, pain with intercourse, constipation and menstrual irregularities. However, these other symptoms are not as useful in identifying ovarian cancer because they are also found in equal frequency in women in the general population who do not have ovarian cancer.

EARLY DETECTION

Early detection of ovarian cancer saves women’s lives. No screening test exists that can test all women for ovarian cancer. The Pap test does not test for ovarian cancer; it screens for cervical cancer.

Not only do researchers need to develop an early detection test for ovarian cancer, like mammograms for breast cancer and Pap tests for cervical cancer, but also women and medical professionals need to become more aware of ovarian cancer symptoms.

While no early detection tool exists for all women, several tests exist for women who are at a high risk. If a woman has ovarian cancer symptoms, a strong family history, or a genetic predisposition such as a BRCA mutation, doctors may monitor her with one of three tests or a combination of them:

Blood Test

  • The protein CA-125 exists in greater concentration in cancerous cells. Though a high count of this protein may help doctors identify ovarian cancer, premenopausal women may have an elevated CA-125 due to benign conditions unrelated to ovarian cancer. Uterine fibroids, liver disease, inflammation of the fallopian tubes, and other types of cancer can raise a woman’s CA-125 level, often causing a false positive test for ovarian cancer.
  • Although the CA-125 blood test is more accurate in postmenopausal women, it is not a reliable early detection test for ovarian cancer. In about 20 percent of advanced stage ovarian cancer cases and 50 percent of early stage cases, the CA-125 is not elevated even though ovarian cancer is present. As a result, doctors generally use the CA-125 blood test in combination with a transvaginal ultrasound.
  • The CA-125 blood test can be an important tool for evaluating the disease’s progress and tumors’ response to treatment. Additionally, this test can monitor a woman’s CA-125 level for evidence of recurrence.
  • OVA1 has also been approved by the Food and Drug Administration (FDA) for risk stratification.  A woman who presents with a known tumor may have this test to determine if her surgery should be done by a gynecologist or a gynecologic oncologist – doctors who are specially trained to treat women with gynecologic cancers.

Transvaginal Ultrasound

  • A transvaginal ultrasound is a test used to examine a woman’s reproductive organs and bladder.
  • To administer the test, the doctor inserts a probe into the woman’s vagina. The probe sends off sound waves which reflect off body structures. The waves are then received by a computer that turns them into a picture.

Pelvic Exam

  • A pelvic exam should be a part of a woman’s regular female health exam.
  • This exam requires the doctor to place one or two fingers into a woman’s vagina and another over her abdomen to feel the size, shape, and position of the ovaries and uterus. Ovarian cancer is rarely detected in a pelvic exam and usually in an advanced stage if it is.

DIAGNOSIS

If a woman has the signs and symptoms of ovarian cancer, her doctor will probably perform a complete pelvic exam, a transvaginal or pelvic ultrasound, and a CA-125 blood test. Used individually, these tests are not definitive; they are most effective when used in combination with each other. Doctors may also use a CT scan or PET scan as part of the diagnostic process. The only definitive way to determine if a patient has ovarian cancer is through surgery and biopsy.

Gynecologic Oncologist
Multiple studies conducted over the past decade have shown that an ovarian cancer patient’s chance of survival is significantly improved when her surgery is performed by a gynecologic oncologist. One analysis of multiple studies found that women whose surgeries were performed by gynecologic oncologists had a median survival time that was 50 percent greater than women whose surgeries were done by general gynecologists or other surgeons inexperienced in optimal debulking procedures. Sometimes referred to as cytoreductive surgery, debulking involves removal of as much of the tumor as possible.

As part of the debulking procedure, doctors try to stage definitively the disease and identify the optimal treatment for the cancer. Proper staging and optimal debulking translate into improved overall survival for women at any stage of ovarian cancer.

Gynecologic oncologists have greater success in treating ovarian cancer as a result of their tendency to perform more aggressive surgery. Women whose tumors have been reduced to less than one centimeter have a better response to chemotherapy and improved survival rate. Gynecologic oncologists also are more likely to perform the multiple peritoneal and lymph node biopsies necessary to ensure adequate surgical staging.

The Women’s Cancer Network has a “Find a Doctor” feature on its Web site (www.wcn.org) where visitors can search for a gynecologic oncologists by ZIP code. Women can also find the nearest gynecologic oncologist by calling (800) 444-4441.

[i] Women’s Cancer Network. Ovarian Cancer Symptoms Consensus Statement. (Accessed June 17, 2009).