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Q&A: Diagnosing Ovarian Cancer

Ovarian cancer is a rare disease, but it is often deadly because it is difficult to diagnose. Usually, by the time it is detected it has already spread.

New guidelines suggest possible warning signs for detecting ovarian cancer. Here are some things to consider when attempting to diagnose the disease:

What do the new guidelines say are possible warning signs of ovarian cancer?

The symptoms include bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and an urgent or frequent need to urinate.

If any of these symptoms arise suddenly — alone or in combination — and if they occur every day or almost daily for more than two or three weeks, the guidelines advise seeing either a primary care doctor or gynecologist to investigate the cause.

Are there tests doctors can use to tell if these symptoms do signal ovarian cancer?

No. Unfortunately, there's no specific test for ovarian cancer, such as the Pap smear for cervical cancer. And, most of the time, the symptoms will not be due to ovarian cancer, which is a rare disease.

Doctors should first closely question patients with these symptoms and try to determine if there's another, more likely explanation — for instance, infection or diet. They should do a careful pelvic exam. But if the symptoms persist without other apparent cause, physicians should not delay in assessing the possibility of ovarian cancer. This can involve ultrasound exams, a blood test called CA-125, and, ultimately, exploratory surgery through a minimally invasive approach called laparoscopy.

What is the CA-125 test and how good is it in diagnosing ovarian cancer or ruling it out?

CA-125 is a protein in the blood which can be associated with ovarian cancer. But the test for CA-125 is notoriously unreliable, since a high level of the protein can be present without having ovarian cancer — and a negative test result doesn't necessarily mean ovarian cancer is absent.

Three years ago the National Preventive Services Task Force recommended against using CA-125 or ultrasound tests to screen women for ovarian cancer. Some doctors use CA-125 in women at high risk for ovarian cancer, due to genetic markers or family history. If levels of CA-125 rise over several successive tests, this can be a signal to explore further.

Why are the new guidelines controversial?

There are two main reasons. First, some doctors fear the guidelines will alarm many women who suffer from the listed symptoms, sending them down the road of costly and unnecessary diagnostic tests — including surgery — for things that will turn out not to be ovarian cancer. Patient advocates argue this can be minimized if women and their doctors pay close attention only to symptoms that are new, regular and persistent for at least several weeks.

Second, experts differ on whether finding ovarian cancer earlier will really lead to higher cure rates. It's possible that by the time symptoms are present, the cancer may already have spread. On the other hand, the total tumor mass may be smaller and thus present a better prospect for cure through surgery and chemotherapy. Only large prospective studies that follow women for several years after diagnosis will answer the question.

How early does ovarian cancer need to be detected to be curable?

The earlier the stage (from Stage I to Stage IV) the greater the chance of cure. About 80 percent of Stage III patients — with cancer outside the ovaries and Fallopian tubes, but still confined to the abdomen — will achieve remissions. This means they will have no visible traces of cancer following treatment. But cancer will recur in 80 percent of those patients who have been in remission.

Among women whose cancer is found when it is still Stage I — confined to the ovary and Fallopian tubes — 93 percent are still alive five years later. However, only one-in-five ovarian cancer patients is diagnosed that early.

Researchers aren't sure how long an ovarian cancer has been growing in a woman's body when she has any given stage of cancer. (By comparison, breast cancer is thought to take years to get to the detectable stage.) It's likely that there are different kinds of ovarian cancer, some more aggressive and fast-growing than others.

What are the current treatment options for ovarian cancer?

Surgery is almost always the first step. Often the ovaries and Fallopian tubes are removed with nearby lymph nodes through a "Band-Aid incision" when the diagnosis is made. At that time, surgeons assess the extent of disease and involvement of other organs, which will determine the stage of cancer — and the scope of further surgery. Doctors usually prescribe chemotherapy of various kinds, since ovarian cancer is assumed to have seeded itself within the abdomen and, perhaps, beyond by the time is has been diagnosed. Chemotherapy is given intravenously, by mouth, and sometimes directly into the abdominal cavity, depending on the type.

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Richard Knox
Since he joined NPR in 2000, Knox has covered a broad range of issues and events in public health, medicine, and science. His reports can be heard on NPR's Morning Edition, All Things Considered, Weekend Edition, Talk of the Nation, and newscasts.