Dr. Brett Parkinson with Mountain Medical tells us more about a disease,
every woman should know about.
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The statistics can seem bleak: once diagnosed with Ovarian Cancer, the overall five-year survival rate is only 45%. However, if the cancer is detected early, when it is still confined to the ovaries, the survival rate jumps to 93%. Although most ovarian cancers are diagnosed after they have spread beyond the ovary, recent studies indicate that earlier recognition of subtle symptoms may lead to improved survival. “There is evidence that these symptoms are present earlier than we have thought,” reports Dr. A.C. Evans, of the division of gynecological oncology at the University of Wisconsin, in a recent USA today article (6/13/07). Currently, only 24 % of ovarian cancers are diagnosed early.
EARLY SYMPTOMS OF OVARIAN CANCER:
• Bloating, a feeling of fullness
• Frequent or urgent urination
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Menstrual disorders, pain during intercourse
• Fatigue, backaches
If any of these symptoms last more than three weeks, or are new, seek medical attention immediately. Although most of the symptoms can occur in conjunction with benign conditions, a thorough clinical exam by a gynecological oncologist should be performed to rule out an underlying, otherwise occult malignancy. Evaluation should include a a bimanual pelvic exam. During such an exam, the doctor feels the ovaries and uterus for size, shape and consistency. But most early ovarian cancers are difficult for even the most skilled clinicians to feel.
RISK FACTORS FOR OVARIAN CANCER:
• Two or more relatives with ovarian cancer
• Family history of multiple cancers: ovarian, breast or colon
• Personal diagnosis of breast cancer before age 50
• Multiple exposure to fertility drugs
• Uninterrupted ovulation (never used birth control pills, no pregnancies)
• BRCA1 or BRCA2 (Breast Cancer) gene mutation
• Ashkenazi Jewish decent
If you are high risk, ask your doctor about screening with the CA125 Blood test and transvaginal ultrasound.
SCREENING TESTS:
There are effective screening tests for other types of cancer, like breast and colon, but there is really no effective screening for ovarian cancer in the general population. However, there are two screening procedures recommended for high risk groups: the CA125 blood test and Transvaginal ultrasound
CA125 is a protein in the blood that is elevated in most ovarian cancers when compared to normal cells. It is produced on the surface of the abnormal cells, and then is released in the blood.
IS THE CA125 TEST ACCURATE?
• Yes and No
• It is truly positive in only 50% of early, or Stage 1 ovarian cancers; it is positive 80% of the time in later stage disease.
• It can be falsely elevated in a variety of other conditions, including several non-malignant women’s reproductive disorders, the first trimester of pregnancy, pelvic inflammatory disease, cirrhosis of the liver, and other types of cancer (especially pancreatic).
• Should never be used alone because of false negative and positive results.
TRANSVAGINAL ULTRASOUND:
• A non-invasive radiological exam to look at the ovaries
• Can detect tumors, but can’t determine whether or not malignant; surgical biopsy is required for diagnosis
• As with the CA125 test, should not be used alone
Early screening trials with the CA125 test and transvaginal ultrasound did not show a reduction in mortality (death rate). However, there is currently a large National Cancer Institute-sponsored trial to test the efficacy of these tests in screening for early ovarian cancer. Stay tuned. Surgery is necessary for a definitive diagnosis.
OVARIAN CANCER TREATMENT:
• SURGERY
The goal of surgery is to remove as much of the cancer as possible. Even in stage 1 disease, a total abdominal hysterectomy is performed, including removal of both ovaries, uterus, fallopian tubes, selected lymph nodes and other tissues in the pelvis and abdomen
• CHEMOTHERAPY
Drugs are used to kill the cancer cells
• RADIATION
High-energy x-rays are used to destroy malignant cells
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