OVARIAN CANCER
INTRODUCTION
Ovarian cancer screening isn’t as simple as getting an ultrasound. The characterization of ovarian masses and distinguishingbetween benign and malignant pathology is important both to decreaseunnecessary anxiety and enable decisions regarding optimal treatment. Benignpathology may be best treated conservatively or in a general gynaecology unitusing a minimal access approach. Conversely, suspected malignant masses shouldbe referred to specialized units for further management. Thus prior knowledgeof the nature of ovarian masses is essential not only for the patient but in order toorganize clinical services in terms of planning, costs and overall management.
Transvaginalultrasonography (TVS) is the most commonly employed imaging modality for theassessment of adnexal masses, and a number of prediction models have beencreated to maximize its predictive capability. In many countries the risk ofmalignancy index (RMI) which combines ultrasound features, serum CA125 levelsand the menopausal status of the patient is still used to characterize ovarianpathology. Unfortunately, both of these are flawed when it comes to screeningthe general population. Asking for a transvaginal ultrasound or blood test whenyou’re at an average risk for ovarian cancer isn’t the best idea.
Thesefindings suggest that with adequate training and knowledge of the commonfeatures associated with particular pathologies, ultrasound examiners should beable to reliably diagnose and differentiate between certain specific types ofadnexal pathology. It is important to remember that when evaluating women withan adnexal mass, ultrasound characteristics need to be correlated with theclinical history, as well as signs and symptoms before arriving at a diagnosis.
Ovariancancer is one of those diseases you probably assume you’re being screened forwhen you go to your well-woman exams, but that’s not really the case. Ovariancancer screening, in fact, isn’t recommended at all for women at average riskfor the condition, but that’s not something that most people know.
Thereare actually no recommended screening tests for ovarian cancer in people whodon’t have symptoms and don’t have an increased risk of developing thecondition.
Ovariancancer is a scary disease—it affects about 20,000 women in the U.S. each year,according to the Centers for Disease Control and Prevention (CDC).Unfortunately, only about 20 percent of cases are caught in the early stages.So it makes sense that we would all want to know how to get screened for thiscondition so that we could discover it and treat it as early as possible.Unfortunately, the science isn’t there yet.
Themanual pelvic exams may be helpful, although ovarian cancers would be verydifficult to feel with this test. When you do a pelvic exam, you’re inserting afinger into the vagina, pushing down from above, and basically feeling for anobvious mass, thickening, or extreme tenderness. It’s very inaccurate as youare just kind of squeezing together the uterus and ovaries. It’s hard to detecta smaller mass.
Whilea transvaginal ultrasound can help find a mass on a woman’s ovary, it can’t tell whetherthat mass is cancerous or benign. When transvaginal ultrasounds are used forscreening, most of the masses found are not cancerous. The CA-125 blood testalso isn’t perfect. More common conditions like endometriosis and pelvic inflammatory diseasecan also cause high levels of CA-125, which could lead to other unnecessarytests. Not only that, not everyone who has ovarian cancer has a high CA-125level.
Asyou can see, knowing the signs and symptoms of ovarian cancer is incrediblyimportant.
Thesymptoms of ovarian cancer can be subtle, but the most common ones includebloating, pelvic or stomach pain, trouble eating or feeling full quickly, andhaving urinary symptoms like feeling to urinate often. This is a little trickybecause these symptoms can also be caused by other benign diseases. But whenthey’re caused by ovarian cancer, they’re usually persistent and a change fromyour normal.
So,who should be tested for ovarian cancer?
Ifyou’re at a higher risk of ovarian cancer, that’s a different story. Women whoare considered higher risk generally include those with inherited genemutations like BRCA1& BRCA2. Your risk may also be increased if you have afamily history of ovarian cancer, if you have had estrogen hormone replacementtherapy (especially over a long period of time and in large doses), and if youstarted your period at an early age or start menopause at a later age. Ingeneral, if a woman has a genetic predisposition to ovarian cancer it isreasonable to consider some type of screening. If you have any of the riskfactors for ovarian cancer, talk to your doctor about your screening options.
