Ovarian Cancer – What EVERY woman NEEDS to know

Ovarian cancer is the 6^th most common cause of cancer death in women in Australia. Every woman has one chance in one hundred of dying from this disease before the age of 85.

While not nearly as common as deaths from breast, colon and lung cancer (all of which are potentially preventable or detectable in early stages), the tragedy of ovarian cancer is that it often presents in an advanced stage where the odds of cure are significantly reduced.

The purpose of this brief article is to inform YOU so you have the best chance of catching this disease early, thus maximising your chance of cure.

What is ovarian cancer?
Ovarian cancer, like all cancers, is an uncontrolled growth of tissue from normal organs. The ovaries sit deep in your pelvis - in a body cavity that has potential plenty of “space to grow”. Because of this, the cancer can get to a large size and spread to other areas within the abdomen before it is obvious something is wrong. Three out of four women with ovarian cancer when diagnosed find that it has spread already beyond the ovary.

The average age of diagnosis is on the mid 50s which is young!

What is not commonly recognised however and this is a CRUCIAL POINT, that 95 % of women actually had early warning symptoms that something was wrong and in many cases these signs were ignored. Women who ignored their symptoms were more likely to be subsequently diagnosed with advanced disease compared to those who sought earlier medical attention

What symptoms do YOU need to look out for so you can get EARLY checkups?
Be mindful of the following:

• Lower abdominal pain or discomfort or pressure
• Abdominal bloating or an increase increased abdominal size
• Constipation
• Lack of appetite/nausea/indigestion
• Irregular menstrual cycles/abnormal vaginal bleeding, pain on intercourse
• Low back pain
• Unexplained tiredness
• Urinary frequency

The importance of early detection to improve survival was thought so critical that The Gynecologic Cancer Foundation, Society of Gynecologic Oncologists, and American Cancer Society issued a consensus statement in 2007 recommending that women who have symptoms such as: Bloating, Pelvic or Abdominal pain, Difficulty eating or feeling full quickly, or Urinary urgency or frequency almost daily for more than a few weeks should see their doctor, preferably a gynaecologist, for further evaluation of ovarian cancer, as well as other potential causes. It is important to specify with your doctor that ovarian cancer is one concern you do have and that this needs to be excluded.

In the presence of these symptoms, how it is diagnosed or what should your doctor so?
You will need at least a Pelvic examination, ultrasound and blood test. The blood test called CA is elevated in 80 percent of women with ovarian cancer and can be normal in 20% of people with ovarian cancer- like many cancer blood tests it is NOT 100 % accurate. If these are suggestive you should be referred to a gynaecology cancer specialist

How can I prevent or have a checkup for this?

Firstly, who is at increased risk?
You MAY be at higher risk if you

• Are of Anglo-Saxon ethnic heritage
• Have never been pregnant
• Started your periods at a young age or had menopause late
• Have a positive family history of ovarian, breast, or (uterine) cancer
• Have a family history of specifically hereditary nonpolyposis colorectal cancer (HNPCC).

Having said that, ALL women are at risk.

Can I get checked regularly - I‘ve heard there is a blood test for this?
Although ovarian cancer is an important cause of cancer death, its incidence and prevalence in the general population are relatively low.

The problem of false-positive screening tests (a test looking for disease before symptoms are present) becomes critically important in diseases with such a low prevalence. Since a positive screening test for ovarian cancer would probably lead to invasive surgery, a large number of healthy women would be undergoing invasive surgery unnecessarily, unless the test or sequence of tests was extremely accurate.

Ovarian tumours are occasionally detected on pelvic examination, although early stage tumours are rarely found due to the deep anatomic location of the ovary. Thus, tumours detected by pelvic examination are usually at an advanced stage and associated with a poor prognosis

The reported blood test is called a CA 125. While Serum CA 125 values are elevated in over 80 percent of women with ovarian cancer, it is elevated in only one in two with early (curable) disease, therefore MISSING up to 50%. It therefore is not a great test. In addition is has an unacceptable false positive rate (showing positive but no cancer is in fact present). CA 125 is also increased in a variety of benign conditions. Furthermore, CA 125 levels are elevated in approximately 1 percent of healthy women and they fluctuate during the menstrual cycle

Screening studies using single measurements of CA 125 have not achieved favourable results and The US Preventive Services Task Force, the American College of Obstetricians and Gynaecologists, the American College of Physicians and the Canadian Task Force on the Periodic Health Examination all recommend against routine screening for ovarian cancer in asymptomatic women. Studies are underway currently still investigating screening- results will not be available for a number of years.

What about ultrasound?
In screening studies in women at high risk of ovarian cancer, ultrasonography has performed poorly in detecting early stage epithelial ovarian cancer

The bottom line is that if you have a positive test, in only 3% of cases, ovarian cancer is present!

Take home messages

1. Ovarian cancer, while not common, is devastating when it occurs because it often presents late.
2. Symptoms are common, often ignored and if acted upon can lead to early diagnosis and cure. Know the symptoms and be your own best advocate for getting yourself checked to ensure you don’t have ovarian cancer.
3. Screening for average risk with blood tests, and ultrasound is not effective. If you are at higher risk, especially with a positive family history, screening may be effective and you should speak to your doctor about this!

References

1. Ovarian cancer in Australia: an overview, 2006 , The Australian Institute of Health and Welfare - http://www.aihw.gov.au/publications/can/oca06/oca06.pdf