Ovarian cancer


Risk Factors

While the presence of one or more risk factors may increase a woman's chance of getting ovarian cancer, it does not necessarily mean she will get the disease. A woman should be extra vigilant in watching for early symptoms. Risk factors include:

  • Personal or family history of breast, ovarian, endometrial, prostate or colon cancer;
  • Hereditary nonpolyposis colorectal cancer or syndrome;
  • Increasing age;
  • Unexplained infertility, no pregnancies and no history of birth control pill usage;
  • Use of high dose estrogen for long periods without progesterone may be a risk factor;
  • North American or North European heritage and/or Ashkenazi Jewish population;
  • Living in an industrialized country

Screening

The sooner ovarian cancer is found and treated, the better a woman's chance for recovery. But ovarian cancer is hard to detect early, especially in the early stages. Some of the more common methods used to screen for ovarian cancer include the following:

  • Pelvic and rectal examination
    The pelvic and rectal examination includes feeling the uterus, and ovaries to find any abnormality in their shape or size. Even though rectovaginal examination is unlikely to detect early stage ovarian cancer, the rectovaginal examination is incorporated into most ovarian cancer screening programs as part of a multimodal approach to screening.
  • Ultrasound
    Ultrasound uses high-frequency sound waves to create pictures of the area being examined. Healthy tissues, fluid-filled cysts, and tumors look different in this picture. Ultrasound may be performed vaginally or abdominally. Ultrasound has demonstrated value in detecting ovarian malignancies in asymptomatic women although its accuracy in detecting early stage disease is poor.
  • CA-125
    The CA125 blood test is used to measure the level of CA-125. Elevated levels of CA125 are often in higher-than-normal amounts in the blood of women with ovarian cancer. Overall, more than 80 percent of women with advanced ovarian cancer will have an elevated CA125 level (greater than 35 u/ml), yet the test is not useful in detecting early stage disease (approximately 50% accurate). Unfortunately CA125 is even less reliable for detecting cancer in pre-menopausal women since it is frequently elevated by non-cancerous conditions such as pregnancy, endometriosis, uterine fibroids, liver disease, and benign ovarian cysts. Most gynecologic oncologists employ CA125 for surveillance of ovarian cancer after the diagnosis has been surgically confirmed since it is a sensitive indicator of persistent or recurrent disease.

Recommendation

Current recommendations for management of women at high risk for ovarian cancer are summarized below:

  • Women who appear to be at high risk for ovarian or breast cancer should undergo genetic counseling and, if the risk appears to be substantial, may be offered genetic testing for BRCA1 and BRCA2.
  • Women who wish to preserve their reproductive capacity can undergo screening by transvaginal ultrasonography every 6 months, although the efficacy of this approach is not clearly established.
  • Oral contraceptives should be recommended to young women before they embark on a planned family.
  • Women who do not wish to maintain their fertility or who have completed their family may undergo prophylactic bilateral salpingooophorectomy. The risk should be clearly documented, preferably established by BRCA1 and BRCA2 testing, before oophorectomy. These women should be counseled that this operation does not offer absolute protection because peritoneal carcinomas occasionally can occur after bilateral oophorectomy.
  • In women who also have a strong family history of breast cancer, annual mammography screening should be performed beginning at age 30 years.
  • Women with a documented HNPCC syndrome should undergo periodic screening mammography, colonoscopy, and endometrial biopsy.