Doctors call ovarian cancer the silent killer: Its symptoms are so vague that women usually don't realize they have the disease until it has become deadly. While an accurate screening test remains elusive, recent reports suggest researchers are closer to catching the disease while it's still treatable.
Ovarian Cancer: Improving the View
In an ongoing study that has spanned two decades, doctors at the University of Kentucky have been using transvaginal ultrasound to annually screen more than 25,000 women who are at increased risk—those ages 50 and older and those 25 and older who have a family history of the cancer. The test was great at detecting abnormalities but less helpful in determining whether they were malignant, says lead study author John van Nagell, MD, director of gynecologic oncology at the university. Of the 25,000 women, 364 were referred to surgery; only 44 ended up having ovarian cancer. "The good news is that 82 percent of the women who had cancer were only at stage one or two. The majority of ovarian cancers are diagnosed at stage three or higher," he says. When the cancer is caught early, the five-year survival rate is 85 to 93 percent; at later stages, the rate is 10 to 30 percent.
Still, the ultrasound's high rate of false positives is a major concern, say experts. Van Nagell and his team are seeing if adding other tools, such as the CA-125 blood test (which checks for elevated levels of a protein that's associated with ovarian cancer), will help cut down on false positives.
A study out of the University of Washington may give women themselves a means of recognizing the cancer earlier. Oncologist Barbara Goff and colleagues compared the symptoms of 149 women with ovarian cancer to those of 488 women who were at high risk but hadn't developed the disease.
The researchers found that the most reliable indicator that cancer was present was more than 12 days a month of these symptoms: cramping in the pelvic region or abdomen, bloating or swelling of the abdomen, or feeling full more quickly than usual. "We can say with some certainty that if you feel this way for at least two weeks and the symptoms are new to you, you're at elevated risk," says Goff, director of gynecologic oncology at the university.
"Know the symptoms and start marking your calendar if you begin to experience them," says Judith Wolf, MD, chair of the National Ovarian Cancer Coalition's medical advisory board. "Then talk to your doctor if they last more than two weeks." Women with a family history of the disease may want to ask their doctor about getting a transvaginal ultrasound and CA-125 blood test twice a year, she adds. (As screenings, the tests may not be covered by insurance.) "These are the best options we can offer until we have a test that can say yes, you have cancer," she says.