How to Test for Ovarian Cancer?

Ovarian cancer is a type of cancer that begins in the ovaries. The ovaries are a pair of female reproductive glands that produce ova (or eggs) for fertilization. They also are the main source of the female hormones estrogen and progesterone.

Types of ovarian cancer include

1. Epithelial tumors: About 90% of ovarian cancers are epithelial tumors, which begin in the thin layer of tissue that covers the outside of the ovaries.
2. Stromal tumors: These tumors occur in the ovarian tissue that contains hormone-producing cells. They account for about 7% of ovarian cancers.
3. Germ cell tumors: These tumors begin in the egg-producing cells. Typically, both younger and older women can be diagnosed with this type of ovarian cancer, but it is rarer.

The exact cause of ovarian cancer remains unknown, but certain risk factors increase the likelihood of developing the disease. These factors include age (most occur in women 50-60 years old), family history of ovarian cancer, certain genetic mutations (like BRCA1 and BRCA2), endometriosis, and reproductive history (like starting menstruation at an early age or starting menopause at a later age).

Symptoms often don’t appear until later stages and can be non-specific, making it difficult to diagnose early. Symptoms include abdominal bloating or swelling, quickly feeling full when eating, weight loss, discomfort in the pelvis area, changes in bowel habits, and a frequent need to urinate.

Impact on Women’s Health:

1. Morbidity and mortality: Ovarian cancer is the fifth most common cause of cancer deaths in women and the deadliest of gynecologic cancers. The disease is often advanced when diagnosed, leading to a high mortality rate.
2. Treatment side effects: Treatments such as surgery, chemotherapy, radiation, and targeted therapy can have severe side effects. These include fatigue, pain, hair loss, infection, nausea, vomiting, and infertility, affecting the physical and emotional well-being of patients.
3. Fertility issues: Ovarian cancer and its treatment can cause infertility, impacting younger women who desire to have children in the future.
4. Psychological impact: The diagnosis and treatment of ovarian cancer can lead to significant psychological stress, anxiety, and depression, affecting the overall quality of life.
5. Genetic implications: Women with a BRCA1 or BRCA2 mutation not only have an increased risk for ovarian cancer but also for breast cancer. This knowledge can cause significant anxiety and lead to preventative surgeries such as mastectomy and removal of the ovaries.

Prevention strategies include taking birth control pills, gynecologic surgery, genetic testing for those at high risk, and lifestyle modifications such as maintaining a healthy weight and not smoking. Due to the often late-stage diagnosis and the significant impact on women’s health, much research is being conducted to find better ways to detect, treat, and prevent ovarian cancer.

Importance of early detection and testing for ovarian cancer

The early detection of ovarian cancer is critically important because it can significantly improve the chances of successful treatment and survival. However, ovarian cancer is notoriously difficult to detect in its early stages, primarily because its symptoms often mimic those of other, less serious conditions.

When ovarian cancer is detected at its earliest stage (stage 1), the five-year survival rate is over 90%. Unfortunately, because early-stage ovarian cancer rarely causes any symptoms, about 70% of all ovarian cancer cases are not found until they have advanced to stage 3 or 4 when the five-year survival rate can be as low as 28%.

Screening and Testing:

Regular screening for ovarian cancer in the general population is not currently recommended by medical organizations because no screening test has been shown to reduce the mortality from this disease. The two tests most commonly used to screen for ovarian cancer are transvaginal ultrasound (TVUS) and the CA-125 blood test, but neither is perfect.

Transvaginal ultrasound (TVUS): This is a test that uses sound waves to look at the uterus, fallopian tubes, and ovaries by putting an ultrasound wand into the vagina. It can help find a mass (tumor) in the ovary, but it can’t actually tell if a mass is cancer or benign.

CA-125 blood test: CA-125 is a protein in the blood. In many women with ovarian cancer, levels of CA-125 are high. However, a high CA-125 level does not mean a woman definitely has ovarian cancer, as many other diseases can also cause the levels to rise. Furthermore, not everyone who has ovarian cancer has a high CA-125 level.

These tests are primarily used in women who have symptoms and in those who are at a high risk of developing ovarian cancer, such as those with mutations in the BRCA1 or BRCA2 genes.

For women with a family history of ovarian cancer or known genetic predisposition, decisions about testing and preventive strategies should be made in consultation with a healthcare provider or genetic counselor. This may include more regular check-ups, performing the CA-125 test and TVUS regularly, or preventive surgeries, like removal of the ovaries and fallopian tubes after childbearing is complete.

Despite the limitations of current screening tests, recognizing the symptoms of ovarian cancer can lead to earlier diagnosis. Symptoms include bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary symptoms (urgency or frequency).

Research is ongoing to develop better methods of early detection. These include more sensitive imaging technologies, more specific biomarkers like CA-125, and genetic testing and profiling. Ultimately, raising awareness about the signs and symptoms of ovarian cancer and advocating for women’s health is essential for early detection and improved outcomes.

Risk factors for ovarian cancer

Age: Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years.

Family history of ovarian cancer: Women with close relatives who have had ovarian or breast cancer have a higher risk of developing the disease.

Inherited gene mutations: A small percentage of ovarian cancers are caused by mutations in certain genes, such as BRCA1 and BRCA2. Women with Lynch syndrome (a genetic condition associated with a high risk of colon cancer) also have a higher risk of ovarian cancer.

Hormone replacement therapy: HRT studies have suggested that women using estrogens after menopause have an increased risk of developing ovarian cancer.

Reproductive history: Women who started menstruating before age 12 or entered menopause after age 52 have a higher risk of ovarian cancer. The risk is also increased in women who have not borne children, had their first child after 30, or experienced infertility.

Endometriosis: Women with endometriosis, where the tissue from the lining of the uterus grows elsewhere in the body, have a higher risk of developing ovarian cancer.

It’s important to remember that having one or several risk factors does not guarantee that one will develop ovarian cancer, just as one can develop it without having any of the risk factors. Regular check-ups, a healthy lifestyle, and discussing any noticeable changes or symptoms with a healthcare provider are the best ways to monitor one’s health.

Conclusion:

Ovarian cancer is a significant health concern for women, particularly because it is often diagnosed in the later stages due to its vague and non-specific symptoms. Composed primarily of three types – epithelial tumors, stromal tumors, and germ cell tumors, ovarian cancer’s risk factors include age, family history, certain genetic mutations like BRCA1 and BRCA2, hormone replacement therapy, reproductive history, and endometriosis.

Due to the serious impact of ovarian cancer on women’s health, including high morbidity and mortality, fertility issues, and psychological stress, early detection is critical. While the currently available screening methods (transvaginal ultrasound and CA-125 blood test) are not foolproof, they can be especially useful in high-risk populations and when symptoms are present. The development of more effective early detection methods is a key area of research.

Public awareness about the signs and symptoms of ovarian cancer is crucial to improving diagnosis rates and outcomes. Women should be encouraged to listen to their bodies, recognize potential symptoms, and seek medical advice promptly. Those with a high risk of ovarian cancer should consider a consultation with a healthcare provider or genetic counselor for personalized strategies on prevention and early detection.

Ovarian cancer has a substantial impact on women’s health worldwide, but advancements in research and heightened awareness can help improve survival rates and the quality of life for those affected.