June
2007
Ovarian Cancer
Ovarian Cancer occurs in about 22,000 American women a year. More than 16,000 of them will die from the cancer, which outnumbers both cervical and uterine cancers combined. If ovarian cancer is diagnosed in the later stages (which is usually the case), the 5 year survival is on 20-30%. On the other hand if diagnosed at Stage I, it is 90-95% 5-year survival.
Risk Factors: majority of women with ovarian cancer don’t have any risk factors. But risk factors include: older age, never pregnant, infertility, family history (10-15% of cases of ovarian cancer), and Ashkenazi Jewish. BRCA 1 or 2 gene is a genetic cause of ovarian cancer (associated with breast cancer; 20-40% lifetime risk of ovarian cancer. In women with BRCA gene, prophylactic removal of ovaries and Fallopian tubes reduces the risk of ovarian cancer down to 5% (cancer can develop in the peritoneal lining despite no ovaries, or there was already an occult – meaning hidden – cancer.)
Screening: because tests are expensive and the prevalence is too low, is not cost effective to screen. Blood test for CA-125 is not recommended because it is used only to follow the course of already diagnosed ovarian cancer. Transvaginal ultrasound is not cost-effective. Doing screening also can be very misleading because a positive test is only correct 10-23% of the time. So 90% of women would have an incorrect positive test, leading to unnecessary emotional distress and surgery. Also doing CA-125 testing with transvaginal ultrasound detects 5% of cases in stage I ovarian cancer according to the PLCO study.
Clinical: 95% women do have symptoms a few month before diagnosis but they are pretty vague – such as abdominal distention, bloating, pelvic pain, constipation, nausea, anorexia, losing appetite soon after eating, and increasing abdominal girth. Statistically it appears the most important symptoms to distinguish ovarian cancer vs. IBS (irritable bowel syndrome) are: pelvic pain, bloating, increasing abdominal girth, urinary urge and frequency,
Diagnosis: CA-125 blood test, transvaginal ultrasound, pelvic examination. Ascites (fluid in the abdominal cavity) can be drained and tested for ovarian cancer. Staging of the cancer is done during surgery – usually laparoscopy Also a complete hysterectomy is done for women who don’t want to bear kids in the future. This means removing the uterus, Fallopian tubes, and ovaries. For those who want to become pregnant in the future, if the cancer hasn’t spread or involved the other ovary, surgery is more sparing – though there is a risk of the spared ovary developing cancer.
Treatment: as mentioned above surgery is needed to remove the cancer. Chemotherapy is usually recommended, though of some controversy.
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drjohnhong 
Uncategorized, women_issues, cancer 
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