|Ovarian Cancer Diagnosis|
Ovarian cancer is a cancer that forms in an ovary. It results in abnormal cells that have the ability to invade or spread to other parts of the body. When this process begins, there may be no or only vague symptoms. Symptoms become more noticeable as the cancer progresses. These symptoms may include bloating, pelvic pain, abdominal swelling, and loss of appetite, among others. Common areas to which the cancer may spread include the lining of the abdomen, lining of the bowel and bladder, lymph nodes, lungs, and liver.
The risk of ovarian cancer increases in women who have ovulated more over their lifetime. This includes those who have never had children, those who begin ovulation at a younger age or reach menopause at an older age.
Other risk factors include hormone therapy after menopause, fertility medication, and obesity. Factors that decrease risk include hormonal birth control, tubal ligation, and breast feeding. About 10% of cases are related to inherited genetic risk; women with mutations in the genes BRCA1 or BRCA2 have about a 50% chance of developing the disease.
The most common type of ovarian cancer, comprising more than 95% of cases, is ovarian carcinoma. There are five main subtypes of ovarian carcinoma, of which high-grade serous carcinoma is the most common. These tumors are believed to start in the cells covering the ovaries, though some may form at the Fallopian tubes. Less common types of ovarian cancer include germ cell tumors and sex cord stromal tumors. A diagnosis of ovarian cancer is confirmed through a biopsy of tissue, usually removed during surgery.
Most of the risk for ovarian cancer is related to the amount of time spent in ovulation. Thus not having children is a risk factor for ovarian cancer, likely because ovulation is suppressed via pregnancy. Both obesity and hormone replacement therapy also raise the risk.
Things that halt ovulation including breast feeding, oral contraceptive use with estrogen/progesterone combination contraceptives, multiple pregnancies, and pregnancy at an early age, all decrease risk of ovarian cancer. These conditions decrease the overall time during one's lifetime spent ovulating. A positive family history of ovarian cancer is a risk factor for ovarian cancer. People with hereditary nonpolyposis colon cancer (Lynch Syndrome), and those with BRCA-1 and BRCA-2 genetic abnormalities are at increased risk.
Ovarian Cancer Diagnosed
Unfortunately, 77% of ovarian cancer cases are diagnosed in an advanced stage, primarily because symptoms that present in the early stages of the disease are often subtle, misinterpreted, inconsistent or ignored. Even routine pelvic exams are unlikely to detect ovarian cancer when it is most treatable before it has spread beyond the ovaries.
The sooner ovarian cancer can be correctly diagnosed, the greater a woman's chances are of surviving it. Ovarian cancer may be uncommon, but it is especially deadly. That's why it is so important for women to be aware of the symptoms and keen to their possible presence at all times.
Screening tests. Scientists and researchers continue to pursue reliable screening methods for the early detection of ovarian cancer. At present, there are a number of tests available that may be of some benefit to women at particular risk for the disease:
- Pelvic exam
Even though a pelvic exam is unlikely to reveal early forms of ovarian cancer, it can still be a useful tool for helping doctors detect variations from baseline conditions. Therefore, it is highly recommended that women age 18 and up have mandatory annual vaginal exams and that women age 35 and up have annual rectovaginal exams (in which the physician palpates the rectum and vagina simultaneously to detect abnormal swelling and tenderness).
- Transvaginal sonography
Usually performed as a precaution among women at high risk for developing ovarian cancer or after a woman has an abnormal pelvic exam, this imaging technique uses an ultrasound instrument placed in the vagina. While more helpful than pelvic exams or CA-125 blood tests alone, the transvaginal ultrasound is limited in its ability to detect cancer early on.
- CA-125 test
This blood test measures levels of CA-125, a blood-borne protein produced by some ovarian cancer cells and by other non-cancerous conditions. Because this blood test may yield elevated (positive) results in the presence of non-cancerous conditions as well, it has a limited capacity for detecting early-stage ovarian cancer.
If preliminary screening methods suggest the presence of ovarian cancer, your healthcare provider may recommend conducting a CT scan, X-ray or biopsy to confirm results.