Some cancers of the female reproductive tract have obvious early warning signs. For uterine cancer, it's bleeding after menopause. For cervical cancer, it's a Pap smear that shows abnormal cells. But ovarian cancer—cancer of the glands that produce eggs and manufacture the hormones estrogen and progesterone-often has no obvious symptoms.
Reasons: In the spacious abdominal cavity, a tumor can grow undetected for years.. and cancer cells can silently spread via the peritoneal fluid in the abdominal cavity.
Result: Among women whose ovarian cancer is caught and treated early-while it is still confined to the ovary—the five-year survival rate is 93%. Unfortunately, of the estimated 22,000 women in the US who are newly diagnosed with ovarian cancer each year, 80% already have cancer that has spread to other parts of the body. For them, the five-year survival rate could be just 20% to 30%.
Self-defense: Determine your level of risk, then follow the protective guidelines below.
Important: Watch for these subtle, easy-to-miss warning signs of ovarian cancer…
- Abdominal swelling or bloating.
- Pelvic pressure or abdominal pain.
- Feeling full quickly when eating.
- Urgent and/or frequent urination.
These same symptoms can be caused by irritable bowel syndrome or urinary incontinence, However, they are more likely to indicate ovarian cancer when symptoms…
- Appeared within the last year.
- Are severe.
- Occur almost every day.
- Last for more than a few weeks.
At High Risk
The average woman's risk for ovarian cancer is relatively small-for every 100 women, fewer than two get the disease. However, certain factors significantly worsen these odds. For instance, for every 100 women who inherit a mutated form of the genes linked to breast cancer (BRCA1, BRCA2), 16 to 60 of them-depending on the specific mutation-are likely to develop ovarian cancer.
You are at high risk if any of these apply…
- Two or more first-degree relatives (mother, sister, daughter) have had ovarian or breast cancer.
- Three or more second-degree relatives (grandmother, aunt) have had ovarian or breast cancer.
- You have a personal history of breast cancer diagnosed before menopause. You are at intermediate-high risk if…
- You have one first-degree relative who has had ovarian cancer.
Self-defense: If your risk is high or intermediate-high, maximize your chances for early detection...
- Get genetic counseling. The counselor maps your family history to determine if genetic testing (for instance, for the BRCA1 and BRCA2 genes) is appropriate. Genetic counseling is available at many university-based cancer centers.
Referrals: National Cancer Institute, 800422-6237, www.cancer.gov.
- Have frequent screening tests. At least once per year, see your gynecologist for a...
- Pelvic exam, during which the doctor manually examines the ovaries and uterus.
- Transvaginal ultrasound, in which a probe is placed in the vagina to check for ovarian tumors.
- Blood test for CA-125, a protein produced by ovarian cancer cells. New study: This test detected about half of early-stage ovarian cancers... and about 80% when used with a symptom questionnaire among high-risk women.
If any of these test results are suspicious, your doctor may order a magnetic resonance imaging (MRI) or computed tomography (CT) scan.
- Consider a laparoscopic exam. A thin, lighted tube inserted via a small incision in the navel region allows the doctor to visually examine the ovaries.
- Ask your doctor about preventive surgery. Surgical removal of the ovaries (oophorectomy) reduces the odds of ovarian cancer by about 95%. (It does not provide 100% protection because microscopic cancer cells already may have existed prior to the surgery.) Insurance generally covers the cost.
Downside: If you are premenopausal, oophorectomy leads to abrupt menopause, which may cause severe hot flashes, mood swings and vaginal dryness. Hormone therapy can ease these symptoms—but may increase risk for breast cancer and heart disease.
At Slightly Increased Risk
Even if you are not at high or intermediate-high risk, your chances of getting ovarian cancer may be above average. Studies have linked increased risk with the following factors…
- Age. Two-thirds of ovarian cancer patients are 55 or older.
- Ethnicity. The disease is most common among Caucasians.
- Menstrual history. Ovulation increases ovarian cancer risk. If you began to menstruate before age 12 and/or reached menopause after age 55, your risk is greater.
- No history of oral contraceptive use. The Pill prevents ovulation, so women who have taken it for at least two years are at lower risk
- History of infertility. This link may be due to increased ovulation and/or decreased progesterone.
- History of endometriosis (overgrowth of the tissue lining the uterus). The link is unclear but may be due to increased inflammation
The more of these risk factors you have, the more vital it is to get annual pelvic exams. Also, ask your doctor if a CA-125 blood test and ultrasound are warranted for you.
At Average Risk
Unfortunately, there is no reliable screening test for ovarian cancer that is appropriate for women who have no risk factors. Studies show that on average, periodic ultrasounds and/or CA-125 testing provide no benefit for women at average risk-no increased level of detection, no lower death rate from the disease--but do lead to unnecessary tests and even surgeries when small cysts are mistaken for cancer.
Several new blood and urine screening tests have received much publicity lately. Called proteomics, this emerging field of research seeks to identify biomarkers for ovarian cancer. But although the early news about these tests was promising, subsequent larger studies showed that none were effective in increasing cancer detection or survival.
Bottom line: If you're at average risk, the only recommended screening tool for ovarian cancer is the all-important annual pelvic exam.
Powder Raises Risk for Ovarian Cancer
Researchers had theorized that inflammation of the ovaries could lead to ovarian tumors--but a recent study found no link.
What does raise risk: Family history...using talcum powder in the pelvic region...and endometriosis (in which the uterine lining migrates outside the uterus).
Robot Surgery-Better for Bladder Cancer
Robotic surgery is now being used to perform bladder removal procedures (cystectomies) that result in similar outcomes and fewer complications for bladder cancer patients compared with traditional open cystectomies. During the robotic procedure, the doctor makes several small incisions in the abdomen, inserts surgical instruments and a tiny camera and removes the bladder. A new channel is created for urine to pass from the body. The robotic procedure also spares the nerves, enabling men to return to normal sexual function after surgery.
If you have bladder cancer: Ask your doctor if robotic cystectomy is an option for you.
Less Invasive Surgery Effective for Colon Cancer
Surgeons usually perform open surgery-making large incisions in the abdominal wall—to view and remove cancerous colon tissue.
Recent finding: An analysis of 12 studies found no differences in rates of surgical complications, cancer recurrence or survival between open surgery and laparoscopic surgery, which involves much smaller incisions and the use of tiny cameras.
Bottom line: Consider a surgeon trained in laparoscopic surgery—it involves less pain and quicker recovery